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Juxta-articular nodules with transepidermal elimination in a patient with Raynaud’s phenomenon:the challenging differential diagnosis between rheumatoid nodule and granuloma annulare

Journal of Dermatology & Cosmetology
Thessaly Puel de Oliveira,1 Luiza Mousquer Leal,2 Bruna Molozzi,3 Jéssica Lajús Fortes Lima,4 Amanda Amaro Pereira,3 Gustavo Moreira Amorim2,4


We report the case of a 51-year-old female who presented with firm, painful papules and
nodules for 9 months, in the extensor proximal metacarpophalangeal and interphalangeal
joints in both hands. She did not have a previous diagnosis of rheumatoid arthritis. She also
denied arthralgia or arthritis. The patient had livedo reticularis and a history compatible
with Raynaud’s phenomenon was reported. The histopathological exam showed well-
developed confluent palisaded granulomas with homogenous eosinophilic necrobiosis,
with signs of initial transepidermal elimination and no mucin. Thus, we are faced withthe
challenging differential diagnosis of rheumatoid nodule preceding rheumatoid arthritis
versus perforating juxta-articular granuloma annulare (pseudorheumatoid nodule).


rheumatoid nodule, granuloma annulare, livedo reticularis, raynaud’s phenomenon, rheumatoid arthritis