A 44-Year-Old Woman With Polyarthritis, Fever, and Hilar Adenopathy: Discussion
Diarrhea, weight loss, arthritis, and generalized lymphadenopathy were the most frequent initial manifestations in patients with Whipple disease seen at the Mayo Clinic. Biopsy reveals tissue infiltration with foamy macrophages with periodic acid Schiff-positive granular inclusions containing bacteria. Patients with Whipple disease may have granulomas on biopsy. Case reports have linked Ureaplasma urealyticum, Chlamydia pneumoniae, and Yersinia pseudotuberculosis infections with simultaneous or subsequent development of classic Lofgren syndrome. The lymphadenopathy in these infectious diseases discussed in this paragraph may reflect either direct involvement of the lymph node by the infectious pathogen or a reactive systemic response to infection. Link
Patients with systemic lupus erythematosus, adult-onset Still disease, hereditary periodic fever syndromes, and vasculitis may present with polyarthritis and lymphadenopathy. Systemic lupus erythematosus arthritis usually presents as a nonerosive, nondeforming arthropathy that has the same distribution as rheumatoid arthritis, including proximal interphalan-geal joints, metacarpophalangeal joints, wrists, and metatarsophalangeal joints. The pain often migrates across several large- and small-joint regions during a 24- to 48-h period. There is little inflammation, except for some tissue swelling around the joints. Deformities, such as ulnar deviation, if present, are usually reducible and are referred to as Jaccoud arthropathy. The synovial fluid has a variable cell count (800 to 40,000/^L with a mononuclear cell predominance) and may have lupus erythematosus cells and/or positive anti-nuclear antibodies. Tenosynovitis and bursitis are common, and nodules may form on the flexor tendons of the hand. Systemic lupus erythematosus can be associated with significant adenopathy, and this occasionally involves the mediastinum. Three histologic patterns have been found in peripheral lymph node biopsies for systemic lupus erythematosus patients. These include collections of lymphoid cells organized in loose follicles with vessels (Castleman disease), follicular hyperplasia with arborizing vessels in the paracortex, and follicular hyperplasia.
Category: Respiratory Symptoms
Tags: erythema nodosum, granuloma, lofgren syndrome, sarcoid arthritis