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2014:80:2;191-193
doi: 10.4103/0378-6323.129424
PMID: 24685876

Multiple cutaneous nodules in a patient with rheumatoid arthritis

Wen-Hui Chen, Chien-Ping Chiang, Bai-Yao Wu
 Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Correspondence Address:
Bai-Yao Wu
Department of Dermatology, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu, Taipei 114
Taiwan
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
Copyright: (C)2014 Indian Journal of Dermatology, Venereology, and Leprology

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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