Table 1: Patient comorbidities.

1.      Rheumatoid arthritis treated with methotrexate, cortisone and possibly reduxima

2.      Lung exfoliation before year for trapped lung and empyema

3.      2017-2018 received anti TNF 2-3 doses

4.      In the winter of 2018, she was hospitalized for a respiratory infection, some nodules are visualized and tuberculosis is suspected, she does BALL which was negative.

5.      In May 2018 she receives Rituximab

6.      In September 2018, she developed a pleural effusion, a lung exfoliation was performed and the culture was negative, but ADA was high.

7.      Since the beginning of 2019, her clinical picture was not good, she had diarrhea and frequent infections.

8.      A smoker