Liver rheumatoid nodules imitating liver malignancy: a rare occurrence

Area of Science:

• Rheumatology
• Hepatology
• Radiology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints.
• RA can have extra-articular manifestations, but hepatic involvement is uncommon.
• Hepatic rheumatoid nodules are a rare, seldom-reported complication of RA.

Observation:

• A 61-year-old man with RA presented with hemoptysis and an upper respiratory tract infection.
• CT and PET scans revealed a 40mm liver mass, raising suspicion for malignancy.
• Fine needle aspiration biopsy was not feasible due to the mass's proximity to the diaphragm.

Findings:

• Surgical resection of the liver mass was performed.
• Histological analysis confirmed necrotizing granulomatous inflammation.
• The findings were consistent with a rheumatoid nodule, a rare hepatic manifestation of RA.

Implications:

• This case expands the spectrum of known hepatic manifestations of rheumatoid arthritis.
• It underscores the importance of considering rheumatoid nodules in the differential diagnosis of liver masses in RA patients.
• Highlights the diagnostic challenges and management of rare hepatic lesions in autoimmune disease.