Isolated Rheumatoid Nodules: A Diagnostic Dilemma

We present a 27-year-old male with multiple nonpainful soft tissue masses over several metacarpals, bilateral elbows, the left wrist, and both knees since the age of 4. Physical exam was significant for firm, nonmobile, nodular growths over the extensor surfaces of bilateral elbows and knees and on...

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Main Authors: Michael Gale, Erin Gilbert, David Blumenthal
Format: Article
Language:English
Published: Wiley 2015-01-01
Series:Case Reports in Medicine
Online Access:http://dx.doi.org/10.1155/2015/352352
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author Michael Gale
Erin Gilbert
David Blumenthal
author_facet Michael Gale
Erin Gilbert
David Blumenthal
author_sort Michael Gale
collection DOAJ
description We present a 27-year-old male with multiple nonpainful soft tissue masses over several metacarpals, bilateral elbows, the left wrist, and both knees since the age of 4. Physical exam was significant for firm, nonmobile, nodular growths over the extensor surfaces of bilateral elbows and knees and on the 2nd and 5th metacarpal phalangeal joints. Laboratory studies revealed an unremarkable rheumatoid factor, negative ANA screening and normal joint radiographs. Differential diagnosis included subcutaneous granuloma annulare (SGA), seronegative rheumatoid nodule, and calcinosis cutis. Biopsy is the only method to distinguish benign rheumatoid nodules from SGA. This case illustrates the importance of biopsy in diagnosis, an awareness of the potential complications, and the need for good follow-up.
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spelling doaj-art-60f8a1b68f174e5ab11f5f35624439c22025-08-20T03:34:57ZengWileyCase Reports in Medicine1687-96271687-96352015-01-01201510.1155/2015/352352352352Isolated Rheumatoid Nodules: A Diagnostic DilemmaMichael Gale0Erin Gilbert1David Blumenthal2Department of Medicine, Woodhull Medical Center, Brooklyn, NY 11206, USADepartment of Dermatology, Woodhull Medical Center, Brooklyn, NY 11206, USADepartment of Medicine, Woodhull Medical Center, Brooklyn, NY 11206, USAWe present a 27-year-old male with multiple nonpainful soft tissue masses over several metacarpals, bilateral elbows, the left wrist, and both knees since the age of 4. Physical exam was significant for firm, nonmobile, nodular growths over the extensor surfaces of bilateral elbows and knees and on the 2nd and 5th metacarpal phalangeal joints. Laboratory studies revealed an unremarkable rheumatoid factor, negative ANA screening and normal joint radiographs. Differential diagnosis included subcutaneous granuloma annulare (SGA), seronegative rheumatoid nodule, and calcinosis cutis. Biopsy is the only method to distinguish benign rheumatoid nodules from SGA. This case illustrates the importance of biopsy in diagnosis, an awareness of the potential complications, and the need for good follow-up.http://dx.doi.org/10.1155/2015/352352
spellingShingle Michael Gale
Erin Gilbert
David Blumenthal
Isolated Rheumatoid Nodules: A Diagnostic Dilemma
Case Reports in Medicine
title Isolated Rheumatoid Nodules: A Diagnostic Dilemma
title_full Isolated Rheumatoid Nodules: A Diagnostic Dilemma
title_fullStr Isolated Rheumatoid Nodules: A Diagnostic Dilemma
title_full_unstemmed Isolated Rheumatoid Nodules: A Diagnostic Dilemma
title_short Isolated Rheumatoid Nodules: A Diagnostic Dilemma
title_sort isolated rheumatoid nodules a diagnostic dilemma
url http://dx.doi.org/10.1155/2015/352352
work_keys_str_mv AT michaelgale isolatedrheumatoidnodulesadiagnosticdilemma
AT eringilbert isolatedrheumatoidnodulesadiagnosticdilemma
AT davidblumenthal isolatedrheumatoidnodulesadiagnosticdilemma