A rheumatoid nodule in an unusual location: mediastinal lymph node

Area of Science:

• Rheumatology
• Pulmonology
• Pathology

Background:

• Rheumatoid arthritis (RA) is a systemic inflammatory condition.
• Pulmonary manifestations are common in RA, with rheumatoid lung nodules being the most frequent.
• Mediastinal lymph node involvement in RA is exceptionally rare.

Observation:

• A male patient with long-standing RA and subcutaneous rheumatoid nodules presented with multiple lung nodules.
• The patient also exhibited mediastinal lymphadenopathies.
• Histopathological examination of a lymph node confirmed necrobiotic granuloma, consistent with RA.

Findings:

• Rheumatoid nodules, typically found in the lungs, can exceptionally occur in mediastinal lymph nodes.
• Necrobiotic granuloma is the characteristic histopathological finding of rheumatoid nodules.
• This presentation underscores the potential for RA to affect mediastinal lymph nodes.

Implications:

• Clinicians should consider rheumatoid nodules in the differential diagnosis of mediastinal lymphadenopathy, especially in patients with advanced RA.
• Awareness of this rare manifestation can aid in accurate diagnosis and management.
• Further research may elucidate the mechanisms behind rare RA manifestations in mediastinal lymph nodes.