BMJ Case Reports 2013; doi:10.1136/bcr-2013-009516

A rheumatoid nodule in an unusual location: mediastinal lymph node

  1. Mazen Kreidy3
  1. 1Department of Rheumatology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
  2. 2Department of Internal Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
  3. 3Department of Pulmonary, Marshfield Clinic, Marshfield, Wisconsin, USA
  1. Correspondence to Dr Ralph Yachoui, yachoui-ralph{at}


Rheumatoid arthritis (RA) is a multisystem inflammatory disease characterised by destructive synovitis and varied extra-articular involvement. Rheumatoid lung nodules are the most common pulmonary manifestations of RA. Rheumatoid nodules in mediastinal lymph nodes are extremely uncommon. We describe a male patient with long-standing RA and subcutaneous rheumatoid nodules presenting with multiple lung nodules and mediastinal lymphadenopathies. Definite histopathology of a lymph node was consistent with necrobiotic granuloma due to RA. Clinicians should be aware of rheumatoid nodules as a potential cause of mediastinal lymphadenopathies, mainly in advanced rheumatoid arthritis.

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