{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T23:37:05Z","timestamp":1784763425100,"version":"3.55.0"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Rheumatoid arthritis (RA) is a systemic inflammatory connective tissue disease that affects 1\u20132% of the population worldwide. Pulmonary manifestations including interstitial lung disease (ILD), airway disease, pleural and vascular disease can be seen in up to 30\u201340% of patients with RA, which are recognized as the second most frequent cause of death in RA patients. The simultaneous occurrence of COVID-19 in RA patients with or without ILD, and the similarities and differences between RA-related ILD and COVID-19 lung findings have been reported in the literature. However, there was no reported case on differentiation of clinical findings of a patient with RA exacerbation causing a new diagnosis of ILD during the pandemic conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>Here, we presented a patient with RA who was misdiagnosed as COVID-19 twice due to non-specific respiratory symptoms and ground-glass opacities observed in high-resolution CT. The misdiagnosis led to a delayed diagnosis of ILD and prolonged pulmonary symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Clinicians must critically review patients throughout the diagnostic workup by thinking other diseases besides COVID-19, particularly in the absence of a confirmatory result. The link between ILD or ILD exacerbation and COVID-19 remains to be determined. While research continues in the field, it is important to consider the importance of COVID-19 in cases of ILD exacerbation, and vice versa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Distinguishing lung imaging findings of COVID-19 from ILD is a major concern. Even though the primary manifestation of COVID-19 consists of respiratory symptoms, clinicians should be vigilant for other common conditions having the same symptoms. Clinicians should carefully distinguish a differential diagnosis between COVID-19 and a flare of rheumatic disease.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.844609","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T12:12:12Z","timestamp":1646914332000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Acute Exacerbation of Rheumatoid Arthritis Misdiagnosed as COVID-19: A Case Report"],"prefix":"10.3389","volume":"9","author":[{"given":"Serife","family":"Torun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irem","family":"Karaman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"B1","first-page":"286","article-title":"Extra-articular manifestations in rheumatoid arthritis.","volume":"5","author":"Cojocaru","year":"2010","journal-title":"Maedica."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/7915340","article-title":"Clinical, epidemiological, and histopathological features of respiratory involvement in rheumatoid arthritis.","volume":"2017","author":"Alunno","year":"2017","journal-title":"Biomed Res Int."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e157","DOI":"10.5114\/pjr.2021.104620","article-title":"Imaging conundrum: COVID-related lung changes or connective tissue disease-related interstitial lung disease.","volume":"86","author":"Vyas","year":"2021","journal-title":"Polish J Radiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"346","DOI":"10.5152\/TurkThoracJ.2021.20172","article-title":"Management of patients with connective tissue disease-associated interstitial lung diseases during the COVID-19 pandemic.","volume":"22","author":"Gurkan","year":"2021","journal-title":"Turk Thorac J."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2020.08.017","article-title":"Acute exacerbation of interstitial lung disease as a sequela of COVID-19 pneumonia.","volume":"361","author":"Fonseca","year":"2021","journal-title":"Am J Med Sci."},{"key":"B6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11845-021-02545-y","article-title":"There are similarities between rheumatic disease with lung involvement and COVID-19 pneumonia.","volume":"191","author":"Williamson","year":"2021","journal-title":"Irish J Med Sci."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1136\/annrheumdis-2020-217627","article-title":"Clinical features of rheumatic patients infected with COVID-19 in Wuhan, China.","volume":"79","author":"Ye","year":"2020","journal-title":"Ann Rheum Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1016\/j.jaccas.2020.04.018","article-title":"Misdiagnosis in the COVID-19 era: when zebras are everywhere, don\u2019t forget the horses.","volume":"2","author":"Yousefzai","year":"2020","journal-title":"JACC Case Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"E145","DOI":"10.1148\/radiol.2020201343","article-title":"Diagnostic performance of CT and reverse transcriptase polymerase chain reaction for coronavirus disease 2019: a meta-analysis.","volume":"296","author":"Kim","year":"2020","journal-title":"Radiology."},{"key":"B10","doi-asserted-by":"publisher","first-page":"363","DOI":"10.12788\/jhm.3461","article-title":"Reducing the risk of diagnostic error in the COVID-19 era.","volume":"15","author":"Gandhi","year":"2020","journal-title":"J Hosp Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.844609\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T12:12:14Z","timestamp":1646914334000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.844609\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":10,"alternative-id":["10.3389\/fmed.2022.844609"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.844609","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,10]]},"article-number":"844609"}}