Multiple cutaneous nodules in a patient with rheumatoid arthritis
Department of Dermatology, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu, Taipei 114
|How to cite this article:
Chen WH, Chiang CP, Wu BY. Multiple cutaneous nodules in a patient with rheumatoid arthritis. Indian J Dermatol Venereol Leprol 2014;80:191-193
A 79-year-old woman presented to the dermatology clinic with multiple papules and nodules on all four limbs which had first developed 6 months previously. Furthermore, she had a 30-year history of seropositive rheumatoid arthritis which was controlled by administering nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs; however, she had no history of tumor necrosis factor-α (TNF-α) inhibitor use. On dermatologic examination, we noted the presence of multiple erythematous to violaceous papules and nodules on her limbs, particularly on the extensor surfaces [Figure - 1].
|Figure 1: Multiple erythematous to violaceous papules and nodules located on the elbow|
Skin biopsy of an erythematous nodule on her elbow was performed. Histopathological examination showed diffuse interstitial and granulomatous infiltration throughout the dermis [Figure - 2]. In addition, dense neutrophilic infiltrates, leukocytoclasia, and histiocytes palisading around the degenerated collagen were observed. In addition, granular basophilic debris was noted in the areas of sclerosis [Figure - 3].
|Figure 2: Histopathology showing diffuse interstitial and granulomatous infiltration throughout the dermis with extensive areas of collagen degeneration (H and E, × 20)|
|Figure 3: Palisaded histiocytes surrounding the center of the area with basophilic degeneration of collagen, numerous neutrophils, fibrin, and leukocytoclasia (H and E, × 200); inset with higher magnification (H and E, × 400)|
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