Methotrexate (MTX)-induced accelerated nodulosis (MIAN) reportedly occurs in patients with rheumatic arthritis receiving MTX therapy. However, it has also been reported in patients with other autoinflammatory conditions, such as systemic lupus erythematosus (SLE). A 38-year-old woman diagnosed with SLE presented with multiple movable, firm, flesh-colored nodules on both hands that had developed 3 years ago. She was taking oral medications, specifically hydroxychloroquine, azathioprine, and MTX. Histopathological examination revealed palisaded granulomatous inflammation, surrounded by histiocytes and lymphocytes, along the dermis to the subcutaneous fat layer. Fibrinoid degeneration was observed at the center of the granulomatous inflammation, and dermal mucin deposition was not observed. The patient was diagnosed with MIAN, and therefore discontinuation of MTX was recommended. Subsequently, the lesions almost completely disappeared with no signs of recurrence. MIAN exhibits clinicopathological features similar to those of rheumatoid nodules; therefore, it can be easily misdiagnosed. Herein, we report a case of MIAN in a patient with SLE to contribute to the accurate diagnosis and appropriate management.
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http://dx.doi.org/10.5021/ad.21.312 | DOI Listing |
Breathe (Sheff)
October 2024
Rheumatology Department, Newcastle Upon Tyne University hospitals, Newcastle, UK.
https://bit.ly/3WBhgOe.
View Article and Find Full Text PDFAnn Dermatol
November 2023
Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea.
Methotrexate (MTX)-induced accelerated nodulosis (MIAN) reportedly occurs in patients with rheumatic arthritis receiving MTX therapy. However, it has also been reported in patients with other autoinflammatory conditions, such as systemic lupus erythematosus (SLE). A 38-year-old woman diagnosed with SLE presented with multiple movable, firm, flesh-colored nodules on both hands that had developed 3 years ago.
View Article and Find Full Text PDFInt J Dermatol
March 2023
Department of Dermatology, Hospital Egas Moniz, Rua da Junqueira 126, 1349-019, Lisbon, Portugal.
Accelerated nodulosis, the rapid progression/extension of preexisting nodules, is a recognized complication of immunomodulatory therapy, occurring mostly in patients with rheumatoid arthritis treated with methotrexate. As of today, its physiopathology remains incompletely understood, and there are no standardized guidelines regarding its management. Here, we conduct a literature review of the reported cases of drug-induced accelerated nodulosis and add our case of a 79-year-old female with an atypical clinical presentation.
View Article and Find Full Text PDFJ Dermatol
March 2023
Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan.
Clin Exp Rheumatol
September 2023
Division of Rheumatology, University of Washington, Seattle, WA, USA.
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