Open AccessPancreatic Rheumatoid Granulomas: A Case Report of a Rare Complication of Rheumatoid Arthritis
Author(s) -
Sanad Elshebli,
Omar Abureesh,
Heyam Awad
Publication year - 2021
Publication title -
oman medical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.395
H-Index - 31
eISSN - 2070-5204
pISSN - 1999-768X
DOI - 10.5001/omj.2021.37
Subject(s) - medicine , rheumatoid arthritis , complication , granuloma , pathology , epigastric pain , rheumatoid nodule , histiocyte , tuberculosis , arthritis , rheumatoid factor , surgery , vomiting
Cutaneous granulomas presenting as skin nodules are the most common extra-articular manifestations of rheumatoid arthritis (RA). Granulomas are defined as a form of chronic inflammatory response characterized by aggregation of activated histiocytes. Visceral granulomas are a rare complication of long-standing RA and have been described twice in the literature. We report a case of a 55-year-old woman with a 15-year history of RA. The patient presented with epigastric pain and weight loss. Imaging studies showed a large soft tissue mass in the head of the pancreas, which was suspected to be malignant. A Whipple procedure was performed, and histological examination revealed multiple non-caseating granulomas with central liquefaction and neutrophilic infiltrate. Ziehl-Neelsen stain for acid-fast bacilli and tuberculosis polymerase chain reaction were negative. The patients’ granulomas were diagnosed as rheumatoid granulomas. Five years after diagnosis, the patient is doing well and has no complications.