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Recurrently Infected Rheumatoid Nodule Causing Posterior Interosseous Nerve Palsy: A Report of a Rare Case

Kazuhiro Ikeda1,2, Hiromitsu Tsuge2, Takamasa Kudo2

  • 1Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN.

Cureus
|August 7, 2025
PubMed

Insights

This case highlights a painful rheumatoid nodule that mimicked infection, causing nerve palsy. Prompt diagnosis and tailored treatment led to remission and functional recovery.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Neurology

Background:

  • Rheumatoid nodules are typically benign and asymptomatic.
  • Atypical presentations can pose diagnostic challenges.

Observation:

  • A patient presented with a rapidly enlarging, painful elbow mass causing posterior interosseous nerve (PIN) palsy.
  • Histological examination revealed features of a rheumatoid nodule with neutrophilic infiltration, suggesting superimposed infection.

Findings:

  • Despite initial negative cultures, the lesion recurred aggressively.
  • Subsequent pathogen isolation confirmed infection.
  • Adjusting immunosuppressive therapy and administering antibiotics resulted in long-term remission and functional recovery.

Implications:

  • Distinguishing infection from rheumatoid activity is crucial in atypical rheumatoid nodule presentations.
  • This case emphasizes the need for a high index of suspicion for infection in rapidly progressing rheumatoid nodules.
  • Multidisciplinary management is key for optimal outcomes in complex cases.
Keywords:
infectionposterior interosseous nerve palsyrecurrentrheumatoid nodulesurgery

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