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Postgrad Med J 1999;75:111-113 doi:10.1136/pgmj.75.880.111
  • Self-assessment questions

Cutaneous nodules in a patient with polyarthritis

  1. R Handaa,
  2. K Vermab,
  3. P D'Souzab
  1. aAll India Institute of Medical Sciences, New Delhi, India Department of Medicine, bDepartment of Dermatology
    • Accepted 13 May 1998

    A 43-year-old normo-uricaemic man with bilateral, symmetrical, destructive polyarthritis involving the distal and proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows, shoulders, knees and ankles, developed multiple, non-itchy nodules on the hands, arms and the trunk (shown in the figure).

    Figure Multiple nodules on the patient's arms

    Questions

    1
    What is the diagnosis ?
    2
    What conditions come in the differential diagnosis ?
    3
    What conditions are associated with this entity ?
    4
    How is this condition managed ?

    Answers

    QUESTION 1

    Multicentric reticulohistiocytosis (MCRH). This is a rare systemic disease characterised by tissue infiltration with lipid-laden histiocytes (macrophages) and multinucleated giant cells. Destructive polyarthritis and skin lesions are the most common findings.

    QUESTION 2

    MCRH should be differentiated from rheumatoid arthritis with nodulosis, xanthomata, tophaceous gout, sarcoidosis, psoriatic arthritis, methotrexate-induced nodulosis, and fibroblastic rheumatism (boxes FB1 and FB2).

    Figure FB1
    Figure FB2
    Figure FB3

    QUESTION 3

    MCRH has been associated with a variety of conditions such as hypercholesterolaemia, malignancy, tuberculosis, diabetes mellitus, hypothyroidism, Sjogren's syndrome, …

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