CASE PRESENTATION: Here we report one case with a typical pulmonary presentation, confirmed through computed tomography (CT) and histopathological studies. A 58-year-old male patient with a diagnosis of RA, complained pain of multiple joints and mild dyspnea on exertion. He was an active smoker (40 pack- years) and worked as a shepherd for 35 years exposed to dust. High-resolution CT (HRCT) of the chest revealed bilateral, round, well-delimited nodules with peripheral distribution. After one month of treatment with corticosteroids and tripterygium wilfordii, the patient’s pain and dyspnea improved. In the meantime, the pulmonary nodules grew down gradually.