Rheumatoid papules in a patient with acquired immune deficiency syndrome and symmetric polyarthritis

We describe a patient with acquired immunodeficiency syndrome (AIDS) and an unusual rheumatoid factor-positive symmetric inflammatory polyarthritis who met all 7 American College of Rheumatology criteria for RA, but who also had many features suggestive of seronegative inflammatory arthritis. Although cutaneous vasculitis has also been described in human immunodeficiency virus infection, this is the first report of cutaneous extravascular necrobiotic granuloma (rheumatoid papule) in AIDS. This case highlights the immunopathogenesis of inflammatory arthritis in AIDS and illustrates the difficulties in making a classic rheumatic diagnosis in the setting of the immune dysregulation caused by AIDS.