Pulmonary Complications of Rheumatoid Arthritis Presenting as Spontaneous Pneumothorax and Empyema: A Case Report.

Rheumatoid arthritis (RA) is a systemic autoimmune disease with well-recognized pulmonary manifestations. While interstitial lung disease and pleural effusions are common, spontaneous pneumothorax complicated by empyema is infrequently reported and may pose significant diagnostic and therapeutic challenges, particularly in immunocompromised patients. We report the case of a 58-year-old woman with long-standing RA and diabetes mellitus who presented with acute dyspnea and pleuritic chest pain. Imaging revealed a right-sided spontaneous pneumothorax with pleural effusion. Despite intercostal drainage and broad-spectrum intravenous antibiotics, the patient developed a loculated empyema requiring surgical decortication. This case highlights the importance of early imaging, close monitoring of chest tube response, and timely surgical referral in complex pleural infections associated with RA.