A 55 year old female with rheumatoid arthritis who was repeatedly admitted to internal medicine for fever, shortness of breath and pleuritic chest pain. Laboratory work up showed normal WBC but elevated CRP and sedimentatation rate. Cultures were negative. Imaging studies revealed elevated diaphragms, bilateral atelectasis and pleural fluid but normal lung parenchyma. Lung function testing showed restriction. Anti-dsDNA and anti-Ro/SSA were elevated. A clinical diagnosis of anti-TNF-induced lupus secondary to infliximab and shrinking lung syndrome was made. The patient showed improvement on steroids but subsequent worsening when tapered. Rituximab was then initiated with good results. Key words: rheumatoid arthritis, infliximab, restrictive lung disease, shrinking lung syndrome, anti-TNF induced lupus. Correspondence: Thorunn Halldora Thordardottir, thorhtho@landspitali.is.
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