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Erschienen in:
13.03.2017 | Clinical Practice: Clinical Images
Painful Plantar Lesions: An Unusual Presentation for Rheumatoid Nodules
Erschienen in: Journal of General Internal Medicine | Ausgabe 8/2017
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A 59-year-old man with rheumatoid arthritis on long-term methotrexate presented with 6 months of multiple painful lesions on his heels that impaired his gait. He denied any trauma to his foot or new medications. Physical examination revealed multiple painful papules and nodules on his heels (Fig.1). A skin biopsy of a nodule showed diffuse interstitial and granulomatous infiltration throughout the dermis, with a central area of necrosis surrounded by palisading epithelioid macrophages (Fig.2), findings consistent with rheumatoid nodules (RN).
Figure 1
Nodules on the heels.
Figure 2
Granuloma with a central area of necrosis (black arrow) surrounded by palisading epithelioid macrophages (yellow arrow) enclosed by granulation tissue (blue arrow).
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