Left-Sided Flank Pain, Fevers, and Fatigue in a 26-Year-Old Male With Seropositive Rheumatoid Arthritis.
- Bharat Kumar
- Arthritis care & research
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by erosive arthritis. Sarcoidosis is a chronic disease characterised by formation of non-calcified granulomas. Our case, a 35-year-old woman, presented with metacarpophalangeal, proximal interphalangeal (PİP) joints and arthritis of both ankles, of 6-month duration. She had morning stiffness lasting 1 h, restriction of range of motion and erythaema nodosum. Laboratory tests showed elevated acute phase responses and serum ACE levels, and anti-cyclic citrullinated peptide antibody positivity. There was periarticular osteoporosis on her hand and wrist on direct X-rays and hilar lymphadenopathy on her thorax CT. The pathological result of endobronchial ultrasound biopsy showed non-calcified granuloma congruent with sarcoidosis. According to clinical, laboratory and histopathological evaluation, the patient was diagnosed with RA and sarcoidosis. Corticosteroids and methotrexate were started, and on her sixth month of follow-up, her clinical and laboratory findings and lymphadenopathies on CT had regressed. The clinical follow-up continues; the patient appears to be in clinical remission.