A rheumatoid nodule in an unusual location: mediastinal lymph node

Abstract

Rheumatoid arthritis (RA) is a multisystem inflammatory disease characterised by destructive synovitis and varied extra-articular involvement. Rheumatoid lung nodules are the most common pulmonary manifestations of RA. Rheumatoid nodules in mediastinal lymph nodes are extremely uncommon. We describe a male patient with long-standing RA and subcutaneous rheumatoid nodules presenting with multiple lung nodules and mediastinal lymphadenopathies. Definite histopathology of a lymph node was consistent with necrobiotic granuloma due to RA. Clinicians should be aware of rheumatoid nodules as a potential cause of mediastinal lymphadenopathies, mainly in advanced rheumatoid arthritis.

Formation of multiple pulmonary nodules during treatment with leflunomide

“…A relevant aspect in the case reported here is that the pulmonary nodules were likely related to the use of leflunomide, since there are several arguments in favor of this hypothesis: the patient in question had a long-term history of RA and had shown no signs of pulmonary involvement prior to treatment with leflunomide; pulmonary rheumatoid nodules can appear during treatment with leflunomide; and there have been reports of peripheral and/or pulmonary rheumatoid nodules in patients undergoing treatment with leflunomide. ( 8 , 15 , 16 )…”

“…Um aspecto relevante no caso relatado é que os nódulos pulmonares, provavelmente, estavam relacionados ao uso da leflunomida, pois existem vários argumentos a favor dessa hipótese: a paciente em questão tinha história de AR de longa data, sem comprometimento pulmonar antes do tratamento com leflunomida; nódulos reumatoides pulmonares são menos frequentes em mulheres que em homens; nódulos pulmonares isolados podem aparecer durante o tratamento com leflunomida; e existem relatos de nódulos reumatoides periféricos e/ou pulmonares em pacientes em tratamento com leflunomida. ( 8 , 15 , 16 )…”