Kamio N, Kuramochi S, Wang R J, Hirose S, Hosoda Y
Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
Pathol Int. 1996 Jul;46(7):526-30. doi: 10.1111/j.1440-1827.1996.tb03649.x.
Rheumatoid nodule is a frequent and characteristic extra-articular manifestation of rheumatoid arthritis (RA). Its involvement of central nervous system is a rare occurrence with only a few reported cases. A 78-year-old man with severe arthritis showing the formation of rheumatoid nodule-like granulomas in the dura and subarachnoid space along with the spleen is presented. The characteristic morphological finding of the granulomas was the presence of neutrophils and the absence of definite fibrinoid necrosis, which differed from the typical features of rheumatoid nodules previously described. The diagnosis should be based on the exclusion of diseases that may cause similar granulomatous reactions including infectious diseases. Additionally, there was systemic necrotizing vasculitis in the dura and multiple cerebral infarcts, although the association between vasculitis and cerebral infarcts was not clear.
类风湿结节是类风湿关节炎（RA）常见且具有特征性的关节外表现。其累及中枢神经系统较为罕见，仅有少数病例报道。本文报告了一名78岁患有严重关节炎的男性，其硬脑膜和蛛网膜下腔以及脾脏出现类风湿结节样肉芽肿。肉芽肿的特征性形态学表现为存在中性粒细胞且无明确的纤维蛋白样坏死，这与先前描述的类风湿结节的典型特征不同。诊断应基于排除可能导致类似肉芽肿反应的疾病，包括感染性疾病。此外，硬脑膜存在系统性坏死性血管炎和多发性脑梗死，尽管血管炎与脑梗死之间的关联尚不清楚。
