Subject(s)
Rheumatic Fever/complications , Rheumatic Fever/diagnosis , Rheumatic Nodule/complications , Rheumatic Nodule/diagnosis , Acute Disease , Adolescent , Arthritis/complications , Dyspnea/complications , Echocardiography , Heart/diagnostic imaging , Humans , Male , Rheumatic Fever/drug therapy , Rheumatic Heart Disease/complications , Rheumatic Heart Disease/diagnosis , Rheumatic Heart Disease/drug therapy , Rheumatic Nodule/drug therapySubject(s)
Adrenal Cortex Hormones/therapeutic use , Central Nervous System Diseases/drug therapy , Hydrocephalus/drug therapy , Methotrexate/therapeutic use , Rheumatic Nodule/drug therapy , Sarcoidosis/drug therapy , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/epidemiology , Cognition Disorders/diagnosis , Cognition Disorders/drug therapy , Cognition Disorders/epidemiology , Comorbidity , Drug Therapy, Combination , Female , Humans , Hydrocephalus/diagnosis , Hydrocephalus/epidemiology , Magnetic Resonance Imaging , Middle Aged , Recurrence , Rheumatic Nodule/diagnosis , Rheumatic Nodule/epidemiology , Sarcoidosis/diagnosis , Sarcoidosis/epidemiology , Treatment OutcomeABSTRACT
Conjunctival nodule is very rarely seen in patients with rheumatoid arthritis. Previously reported cases were associated with the use of methotrexate. Here, we report a conjunctival rheumatoid nodule without such prior treatment. A 49-year-old woman with seropositive rheumatoid arthritis, who was being treated only with oral steroids and hydroxychloroquine, developed diffuse anterior scleritis in the right eye. In addition, examination showed a focal raised yellow/tan conjunctival nodule. The nodule was within the bulbar conjunctiva with no attachments to the underlying tissue, which is different from nodular scleritis. The nodule was not tender on palpation. The patient underwent excisional biopsy of the nodule. Intraoperatively, the lesion was noted to be a firm nodule within substantia propria of the conjunctiva. Hematoxylin-eosin staining of the specimen revealed a central area of necrosis surrounded by palisades of histiocytes. Increased dosage of oral steroid after the biopsy resulted in resolution of the ocular symptoms and signs. In conclusion, rheumatoid nodules may be seen in the conjunctiva even without prior treatment with methotrexate. These nodules may show the severity of the underlying disease and the need for more aggressive treatment.
Subject(s)
Conjunctiva/pathology , Conjunctival Diseases/pathology , Rheumatic Nodule/pathology , Administration, Oral , Biopsy , Conjunctival Diseases/drug therapy , Conjunctival Diseases/surgery , Diagnosis, Differential , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Middle Aged , Ophthalmologic Surgical Procedures/methods , Rheumatic Nodule/drug therapy , Rheumatic Nodule/surgeryABSTRACT
UNLABELLED: Calcaneal osteomyelitis is uncommon and difficult to treat. Cases due to fistulization of an infected rheumatoid nodule are exceedingly rare. PATIENT: A 65-year-old patient with nodular rheumatoid arthritis (RA) experienced osteomyelitis of the left calcaneus due to inoculation from a fistula draining an ulcerated rheumatoid nodule. Pseudomonas aeruginosa and Enterobacter cloacae were recovered. The conventional treatment of calcaneal osteomyelitis relies on antibiotics and calcanectomy or foot amputation. We used two appropriate antibiotics and monthly intravenous injections of 90 mg of pamidronate. RESULT: One year into treatment, the patient was free of pain and the skin wound was fully healed. On a follow-up computed tomography (CT) scan, the fistulous tract was seen to be closed and the large calcaneal defect almost completely filled with new bone. CONCLUSION: Combining two antibiotics and pamidronate may be a viable alternative to excision surgery or amputation in some patients with bone infection carrying a risk of fracture.
Subject(s)
Calcaneus , Cutaneous Fistula/complications , Osteomyelitis/etiology , Rheumatic Nodule/complications , Ulcer/complications , Aged , Anti-Bacterial Agents/therapeutic use , Bone Density Conservation Agents/therapeutic use , Diphosphonates/therapeutic use , Drug Therapy, Combination , Follow-Up Studies , Humans , Male , Osteomyelitis/diagnostic imaging , Osteomyelitis/drug therapy , Pamidronate , Rheumatic Nodule/diagnostic imaging , Rheumatic Nodule/drug therapy , Tomography, X-Ray ComputedABSTRACT
A 67-year-old woman with rheumatoid arthritis was hospitalized because of dysphagia and severe nodulosis. Over a two-year period the patient had been treated with methotrexate. A computed tomography (CT) scan of the neck showed a 2 x 2 cm large tumour behind the top left lateral thyroid cartilage. A biopsy taken during direct laryngoscopy showed it was a rheumatic nodule. Treatment with colchicine reduced the patient's dysphagia. As methotrexate is used increasingly in the treatment of rheumatoid arthritis and as this particular drug causes rheumatic nodules in five to 10 per cent of the patients, it must be foreseen that the incidence of nodules in the upper airways will increase.
Subject(s)
Antirheumatic Agents/adverse effects , Laryngeal Diseases/chemically induced , Methotrexate/adverse effects , Rheumatic Nodule/chemically induced , Aged , Colchicine/therapeutic use , Female , Gout Suppressants/therapeutic use , Humans , Laryngeal Diseases/diagnostic imaging , Laryngeal Diseases/drug therapy , Laryngoscopy , Rheumatic Nodule/diagnostic imaging , Rheumatic Nodule/drug therapy , Tomography, X-Ray ComputedSubject(s)
Dermatitis/diagnosis , Edema/diagnosis , Eosinophilia/diagnosis , Hypersensitivity, Immediate/diagnosis , Rheumatic Diseases/diagnosis , Rheumatic Nodule/diagnosis , Adult , Cetirizine/therapeutic use , Cimetidine/therapeutic use , Dermatitis/drug therapy , Dermatitis/immunology , Diagnosis, Differential , Edema/drug therapy , Edema/immunology , Eosinophilia/drug therapy , Eosinophilia/immunology , Follow-Up Studies , Histamine H1 Antagonists/therapeutic use , Histamine H2 Antagonists/therapeutic use , Humans , Hypersensitivity, Immediate/drug therapy , Hypersensitivity, Immediate/immunology , Male , Rheumatic Diseases/drug therapy , Rheumatic Diseases/immunology , Rheumatic Nodule/drug therapy , Rheumatic Nodule/immunologyABSTRACT
Laryngeal involvement in systemic lupus erythematosus (SLE) can range from mild ulcerations, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. In this report, four cases showing the range of severity of this disease manifestation are presented, accompanied by a comprehensive review of the literature. The clinical course of 97 patients with laryngeal involvement with SLE are reviewed, of whom 28% had laryngeal edema and 11% had vocal cord paralysis. In the majority of cases, symptoms such as hoarseness, dyspnea, and vocal cord paralysis resolved with corticosteroid therapy. Other, less common causes of this entity included subglottic stenosis, rheumatoid nodules, inflammatory mass lesions, necrotizing vasculitis, and epiglottitis. The clinical presentation of laryngeal involvement in patients with SLE follows a highly variable course, ranging from an asymptomatic state to severe, life-threatening upper airway compromise. With its unpredictable course and multiple causations, this complication remains a diagnostic and therapeutic challenge to physicians involved in the care of patients with SLE.
