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Case Reports in Medicine
Volume 2015, Article ID 352352, 3 pages
http://dx.doi.org/10.1155/2015/352352
Case Report

Isolated Rheumatoid Nodules: A Diagnostic Dilemma

1Department of Medicine, Woodhull Medical Center, Brooklyn, NY 11206, USA
2Department of Dermatology, Woodhull Medical Center, Brooklyn, NY 11206, USA

Received 26 November 2014; Accepted 1 February 2015

Academic Editor: Michail Varras

Copyright © 2015 Michael Gale et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.