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A 60 year old lady with anti-CCP and sero-positive rheumatoid arthritis [RA] on methotrexate (MTX, 20 mg once weekly), hydroxycholroquine (HXQ, 200 mg twice daily), azathioprine (AZA, 50 mg twice daily), pre-sented with a history of weight loss (2 stone in 6 months), poor appetite for 5 months, non-productive cough and non exertional shortness of breath of few days duration. Examination was unremarkable except for mouth ulcers, an erythematous rash with irregular borders above the mycin therapy was commenced. CT scan revealed mediastinal (complex confluent subcarinal lymph node mass measuring 5.6 cm), aorto-pulmonary, paratracheal, right tracheobronchial, axillary, upper abdominal (1.5 cm), external ileac and right inguinal lymphadenopathy (largest 10.7 mm). There was widespread reticulonodular shadowing, subpleural consolidation and congestion of interlobular lymphatics. A small right pleural effusion and little pleural thickening/pleural reaction was reported in dependent parts of the left lower lobe (Figure 1).modality for RA as well as PLG.[RA] presenting with clinical-pathological and radiological features of Pulmonary Lymphomatoid Granulomatosis (PLG). This is a rare lung disorder characterized by multiple nodular lesions with lymphocytic invasion of vascular walls. We present one such case of PLG sec-ondary to Methotrexate and Azathioprine therapy, who was successfully treated with Steroids and Rituximab. We wish to highlight the importance of lung biopsy in the diagnosis and the use of rituximab as a treatment raised neutrophil count, and CRP was elevated too. Bio-chemical profile was unremarkable. Chest x-ray revealed increased coarse, linear shadowing in the mid- and lower zones, prominent hila, bilateral Kerley B lines, and a pleural reaction on the left. Nodular shadows were present bilaterally, the largest measuring 18 mm. Methotrexate and Azathioprine were discontinued. As concerns were raised about methotrexate lung disease, Folinic acid rescue was instituted and broad spectrumAbstract We report the case of a patient with Rheumatoid Arthriti