We report a case of Caplan syndrome complicated with tuberculosis, which was clinically followed up for 18 years and underwent autopsy. Initial chest radiograph showed 2 large nodules against the background of smaller pneumoconiotic nodules. One of the large nodules showed cavitation during follow-up. Computed tomography (CT) was helpful in identifying calcification in another large nodule. Autopsy confirmed the 2 large nodules as burned-out rheumatoid nodules and revealed additional rheumatoid nodules that were indistinguishable from silicotic nodules by CT.