Nódulo reumatoide benigno en sóleo. Reporte de un caso / Benign rheumatoid nodule in the soleus muscle. Case report

RESUMEN Los nódulos reumatoides benignos son nódulos subcutáneos, idénticos en su morfología e histología a los que ocurren en el transcurso de la artritis reumatoide (AR), que aparecen en personas sin síntomas de artritis y con factor reumatoide (FR) negativo. Se presenta el caso de un varón de 46 arios de raza caucasiana que consultó por tumoración en la pierna derecha. Destacaba negatividad de factor reumatoide, anticuerpos anti péptido citrulinado, anticuerpos antinucleares y anticuerpos anticitoplasma de neutrófilo, así como normalidad de los reactantes de fase aguda. Una ecografía musculoesquelética mostró una tumoración sólida de 3,5 x 1,5 cm, de márgenes bien definidos, en músculo sóleo, con una estructura heterogénea hipoecoica con vascularización intra y perilesional. La resonancia magnética evidenció una tumoración de carácter fibroso sin datos sugestivos de agresividad. Una biopsia guiada por ecografía mostró histología característica de nódulo reumatoide. Se discuten la clínica, el diagnóstico, el diagnóstico diferencial y el tratamiento de los nódulos reumatoides benignos.

ABSTRACT Benign rheumatoid nodules are subcutaneous nodules, identical in morphology and histo logy to those that occur in the course of rheumatoid arthritis. They appear in people without symptoms of arthritis and with negative rheumatoid factor. The case is presented of a 46-year-old Caucasian man who consulted for a tumour inthe right leg. He was negative for rheumatoid factor, anti-citrullinated protein antibodies, antinuclear antibodies, and antineutrophil cytoplasmic antibodies, as well as for acute phase reactants. A musculoskeletal ultrasound showed a solid tumour of 3.5 × 1.5 cm with well-defined margins in the soleus muscle, and with a heterogeneous hypoechoic structure with intra- and peri-lesional vascularisation. The magnetic resonance imaging showed a fibrous tumour with no signs suggestive of aggressive growth. An ultrasound-guided biopsy sho wed the characteristic histology of the rheumatoid nodule. The clinical picture, diagnosis, differential diagnosis, and treatment of benign rheumatoid nodules are discussed.

Case for diagnosis. Subcutaneous nodules in the plantar region

Abstract The authors report a case of mobile and painful nodules on the bilateral plantar surface of a female patient referred by the rheumatology service, where she was being followed-up for rheumatoid arthritis. A nodule excision was performed for differential diagnosis and symptom relief; the histopathological analysis was compatible with a rheumatoid nodule. Although rheumatoid nodules are a common manifestation of rheumatoid arthritis, exclusive plantar involvement is seldom described in the literature.

Nódulo pulmonar cavitado en artritis reumatóide: reporte de un caso / Cavitating pulmonary nodule in rheumatoid arthritis: A case report

RESUMEN Los nódulos reumatoides pulmonares son una manifestación extra-articular infrecuente de la artritis reumatoide (AR). Su estudio es importante porque su presentación clínica e imagenológica puede confundirse con tuberculosis, infecciones fúngicas y neoplasias pulmonares. Producen pocos síntomas y pueden conducir a complicaciones fatales como neumotórax, fístula broncopleural y sobreinfección con formación de abscesos. La confirmación diagnóstica fundamental descansa en el estudio histopatológico, dado que es un diagnóstico de exclusión. El tratamiento precisa seguimiento clínico ya que no hay una terapia dirigida utilizándose en casos severos rituximab y tocilizumab. En general, su aparición tiende a empobrecer el pronóstico de los pacientes con AR.

ABSTRACT Pulmonary rheumatoid nodules are an uncommon extra-articular manifestation of rheumatoid arthritis (RA). Its study is important because the clinical and imaging presentation could be confused with tuberculosis, fungal infections, and/or lung neoplasms. Pulmonary nodules produce few symptoms and can lead to fatal complications such as pneumothorax, bronchopleural fistula, and a superinfection with abscess formation. The fundamental diagnostic confirmation is the histopathological study because it is an exclusion diagnosis. The treatment needs clinical follow-up as there is no targeted therapy, with Rituximab and Tocilizumab being used in severe cases. In general, their appearance tends to lead to a poorer prognosis of patients with RA.

Rare Form of Rheumatoid Nodule around Ischial Tuberosity Mimicking Ischiogluteal Bursitis

We are reporting about a case of a rheumatoid nodule, beneath the ischial tuberosity, mimicking ischiogluteal bursitis. Rheumatoid nodules are frequently seen, at the subcutaneous soft tissues of repetitive mechanical irritation points, and prominent bones. There have been no reported cases of rheumatoid nodules, extending just beneath the ischial tuberosity bone. A 68-year-old woman with a seven-year history of rheumatoid arthritis, suffered for six months, from right buttock swelling and discomfort in seating. A cystic lesion postero-inferior to the ischial tuberosity, was noted in the MRI scan, which was thought to be ischiogluteal bursitis, because of its characteristic location and appearance. Histopathologic analysis and gross findings on the operation, revealed no evidence of bursitis.

Rare Form of Rheumatoid Nodule around Ischial Tuberosity Mimicking Ischiogluteal Bursitis

We are reporting about a case of a rheumatoid nodule, beneath the ischial tuberosity, mimicking ischiogluteal bursitis. Rheumatoid nodules are frequently seen, at the subcutaneous soft tissues of repetitive mechanical irritation points, and prominent bones. There have been no reported cases of rheumatoid nodules, extending just beneath the ischial tuberosity bone. A 68-year-old woman with a seven-year history of rheumatoid arthritis, suffered for six months, from right buttock swelling and discomfort in seating. A cystic lesion postero-inferior to the ischial tuberosity, was noted in the MRI scan, which was thought to be ischiogluteal bursitis, because of its characteristic location and appearance. Histopathologic analysis and gross findings on the operation, revealed no evidence of bursitis.

Azathioprine-induced accelerated cutaneous and pulmonary nodulosis in a patient with rheumatoid arthritis

We report the case of a 42-year-old female with a 5-year history of rheumatoid arthritis treated with Rituximab and Azathioprine. Three months after the initiation of Azathioprine, the patient started with dry cough and noted the rapid development of multiple subcutaneous nodules on her right leg. CT scan of the chest demonstrates pulmonary nodulosis. Skin biopsy was compatible with rheumatoid nodule. A diagnosis of "accelerated cutaneous and pulmonary nodulosis" was considered. Azathioprine was discontinued and Rituximab was restarted. Two months later, most of the subcutaneous nodules had disappeared. This is the second case report of accelerated rheumatoid nodulosis in association with Azathioprine treatment.

Formation of multiple pulmonary nodules during treatment with leflunomide / Formação de múltiplos nódulos pulmonares durante tratamento com leflunomida

Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis and can be due to the disease itself or secondary to the medications used in order to treat it. We report the case of a 60-year-old woman who had been diagnosed with rheumatoid arthritis and developed multiple pulmonary nodules during treatment with leflunomide.

O comprometimento pulmonar é uma das manifestações extra-articulares da artrite reumatóide e pode ser devido à própria doença ou secundário às medicações utilizadas para seu tratamento. Este trabalho relata um caso de uma paciente de 60 anos de idade com diagnóstico de artrite reumatoide que evoluiu com múltiplos nódulos pulmonares durante o tratamento com leflunomida.

Pulmonary Cryptococcosis That Mimicked Rheumatoid Nodule in Rheumatoid Arthritis Lesion / 결핵및호흡기질환

Recently, the incidence of pulmonary cryptococcosis is gradually increasing in rheumatoid arthritis (RA) patients. Pulmonary rheumatoid nodules (PRN) are rare manifestations of RA. Eighteen months ago, a 65-year old woman was admitted to hospital due to multiple nodules (2.5x2.1x2 cm) with cavitations in the right lower lobe. She was diagnosed with RA three year ago. She had been taking methotrexate, leflunomide, and triamcinolone. A video-assisted thoracoscopic surgery biopsy was performed and PRN was diagnosed. However, a newly growing huge opacity with cavitation was detected in the same site. Pulmonary cryptococcal infection was diagnosed through a transthoracic computed tomograpy guided needle biopsy. Cryptococcus antigen was detected in serum but not in cerebrospinal fluid. The patient was treated with oral fluconazole which resulted clinical improvement and regression of the nodule on a series of radiography. Herein, we report the case of pulmonary cryptococcosis occurring in the same location as that of the PRN.

Nódulos reumatoides: avaliação comparativa da resposta terapêutica com triancinolona e fluoruracil intralesional / Rheumatoid nodules: evaluation of the therapeutic response to intralesional fluorouracil and triamcinolone

Os nódulos reumatoides correspondem à manifestação extra-articular mais comum da artrite reumatoide, ocorrendo em cerca de 20-25 por cento dos pacientes. A etiologia é desconhecida. Apesar de os nódulos poderem apresentar remissão espontânea durante o tratamento, eles, em geral, representam um desafio terapêutico. Apresenta-se um caso no qual se avaliou a resposta dos nódulos reumatoides por meio de ultrassonografia após infiltração de triancinolona e 5-fluoruracil.

Rheumatoid nodules are the most common extra-articular manifestation of rheumatoid arthritis and are present in around 20-25 percent of patients. Their etiology is unknown and although the nodules may undergo spontaneous remission during the treatment of rheumatoid arthritis, they usually constitute a therapeutic challenge. The present paper describes a case in which the response of rheumatoid nodules was evaluated by ultrasound following infiltration of triamcinolone acetonide and 5-fluorouracil.

Etanercept-related Cutaneous Nodulosis in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Etanercept is a recombinant human tumor necrosis factor (TNF) receptor fusion protein, which inhibits the biological activity of TNF-alpha. The common side effects of TNF-alpha inhibitors are injection site reactions, infusion reactions and infection. Rheumatoid nodules are the most common extraarticular manifestation of rheumatoid arthritis. Drugs such as methotrexate were reported to be associated with rheumatoid nodules, but etanercept-related nodules were uncommonly observed. We report the new formation of cutaneous rheumatoid nodules in a 58-year-old man during anti-TNF alpha therapy with etanercept. He had 2-year history of seropositive rheumatoid arthritis, and been treated with methotrexate, hydroxychloroquine, sulfasalazine, prednisolone and nonsteroidal anti-inflammatory drugs before etanercept regimen. Rheumatoid nodules developed on the palmar surface of fingers 4 month after treatment of etanercept, although his disease activity was maintained low. One month later, we decided to stop etanercept because his nodulosis extended to elbow. Since then, he has been followed up without any progression of rheumatoid nodules or aggravation of arthritis.

A Case of Rheumatoid Nodule in a Systemic Lupus Erythematosus Patient / 대한피부과학회지

The twenty percent of rheumatoid arthritis patients experience rheumatoid nodules, particularly over their extensor surfaces. There have been some reports of patients with systemic lupus erythematosus and rheumatoid nodules. A 44 year-old female patient has had a skin lesion on the buttock for one year, which was a slightly depressed brownish indurated patch. She was diagnosed as systemic lupus erythematosus and treated for ten years. Histopathologic findings of the skin lesion showed appearances consistent with rheumatoid nodules. We experienced a case of rheumatoid nodule in a systemic lupus erythematosus patient and first report in Korea.