REPORT OF A CASE
A 42-year-old woman presented with a 5-year history of rheumatoid factor-positive severe rheumatoid arthritis. Her skin problem began about 5 months before presentation. The lesions began on her arms (Figure 1) and legs and then spread to include parts of her forehead and lower abdomen. She also noted lip swelling. She denied pruritus or pain associated with the lesions and had no systemic complaints. The lesions first occurred while she was using prednisone (1 mg/kg per day), methotrexate, and naprosyn. These medications had been discontinued 2 months before presentation because of remission in her rheumatoid arthritis. A skin punch biopsy specimen of a lesion was obtained (Figure 2).What is your diagnosis?
DIAGNOSIS: Rheumatoid neutrophilic dermatitis (RND).
HISTOLOGIC FINDINGS AND CLINICAL COURSE
The biopsy specimen showed a superficial and deep dermal neutrophilic infiltrate without significant involvement of the overlying epidermis. The pattern
Harkaway K, Elenitas R, Margolis DJ. Erythematous Papules in a Patient With Rheumatoid Arthritis. Arch Dermatol. 1995;131(10):1199-1200. doi:10.1001/archderm.1995.01690220105020