Persistent Pulmonary Atelectasis in Patient with Rheumatoid Arthritis Treated with High-Flow Therapy and High-Frequency Chest Wall Oscillation

Rheumatoid arthritis is a systemic inflammatory disorder that affects ～1-2% of the population. Although a progressive destruction of cartilage and bone is the main presentation, extra-articular manifestations can occur in about 40% of patients during the course of their disease and are associated with significant morbidity and increased mortality. Pulmonary complications can frequently occur in these patients, although not always clinically recognized. We present a case of 60-year-old woman suffering from rheumatoid arthritis came to our department for the presence of exertional dyspnea, cough with poor mucous expectoration, chest pain and worsening of daytime asthenia. At a chest x-ray, evidence of right basal pulmonary atelectasis, for which she had practiced antibiotic therapy with persistence of symptomatology and pulmonary atelectasis. Chest CT showed parenchymal consolidation. The patient was treated with antibiotics and rehabilitation therapy, bronchial endoscopy, with persistence of pulmonary atelectasis. She started nasal high-flow therapy but in the seventh day appears epistaxis. For this reason, she suspended treatment with NHF. At the next rehabilitation session, for the recurrence of epistaxis, an otorhinolaryngology visit was performed that confirms the presence of nasal varices. Therefore, the patient started high-flow therapy with a mouthpiece with the use of High Frequency Chest Wall Oscillation. At the end of rehabilitative treatment we observed clinical and radiological improvement