Rheumatoid pneumoconiosis, also known as Caplan's syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. In this article, we report a case of Caplan's syndrome.

We reported one of the rare, documented cases of a girl with LVNC associated jSLE with a past history of Hashimoto’s thyroiditis.Thus, the association between jSLE, and LVNC should be considered, and requires further research in order to find the probable mechanism joining both entities.

Patients with high levels of rheumatoid factor (RF), are more exposed to develop extra-articular manifestations in the course of RA such as rheumatoid nodules, rheumatoid vasculitis and pleuropulmonary, cardiovascular, neurologic, digestive, cutaneous, hematologic and ocular complications [7][8][9]. The most frequently observed are rheumatoid nodules, osteoporosis, Gougerot's syndrome, pleuropulmonary, hepatic and renal manifestations. We reported a case of an early diagnosed RA patient with very rare extraarticular manifestations: axillar, mediastinal and intra-abdominal lymphadenopathies and hepatosplenomegaly, with hematological features.Background: Extra-articular manifestations in rheumatoid arthritis (RA) are rare and generally occur in an advanced stage of the disease. We report a case of an unusual onset of early RA. Case presentation:A 21 year old male complains of polyathritis involving small and large joints, associated with fever, asthenia, anorexia and weight loss. The temperature was up to 38.8°. There was a left cervical adenopathies, hepato-splenomegaly and there were synovitis in all joints sparing distal interphalangial joints. The erythrocyte sedimentation rate was accelerated; the C-reactive protein was up to 222 mg/l. The number of white blood cells were 9000/mm 3 with monocytosis, lymphocytosis and thrombocytosis at 986000/mm 3 . There was cholestasis with cytolysis. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACCP) were positive. The hands X-ray didn't show any RA specific signs. The chest X-Ray showed a left pleurisy. The CT scan showed multiple axillar and mediastinal lymphadenopathies, hepato-splenomegaly with multiple coelio-mesenteric and retroperitoneal lymph nodes. The pleural biopsy as well as the biopsy of the adenopathy and the salivary glands didn't show any specific abnormalities or signs of lymphoma. The hepatic biopsy revealed an inflammatory lymphohistiocytic infiltrate with rare foci of necrosis and a dilatation of the hepatic sinusoids. The diagnosis of RA was suspected and confirmed by the MRI of the hands. Conclusion:RA may have an unusual onset such as hematologic, hepatic, pleuropulmonary features or tumor syndrome, but it is rarely reported. The diagnosis in this case is difficult.

Background: Caplan's syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. Here we report a case of a patient diagnosed with RA after diagnosed silicosis.

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