Pseudorheumatoid Nodules of Eyelid and Ocular Adnexae. (A case report)

Pseudorheumatoid nodules (PRN) are subcutaneous necrobiotic granulomas that arehistopathologically similar or identical to those seen with rheumatoid arthritis, granulomaannulare, necrobiosis lipoidica diabeticorum, and systemic lupus erythematosus. thesenodules are most common in children, they are also seen in adults and are usually located onthe extremities and scalp. Eyelid and eyebrow involvement is seen infrequently. In previousreports of these nodules were most frequently located in the lateral upper eyelids and outercanthal region, and in some cases were multiple. Pseudorheumatoid nodules may be indicatedwhen a healthy child or a young adult presents with solitary or multiple subcutaneousnodules, especially in the eyelids. These lesions presented as a painless subcutaneousnodule(s), and pursued a benign clinical course and local excision, which is usuallyperformed for diagnostic purposes, was the only treatment indicated. The lesions had atendency to regress spontaneously; therefore, local recurrences should be treatedconservatively by periodic follow-up examinations.Histopathologically they resembled the subcutaneous nodules of rheumatoid arthritis andrheumatic fever. All lesions showed the presence of necrobiosis; however, one of thecharacteristic features was the multinodular character of the predominantly mononuclearcellular aggregates. The presence of vascular spaces at the periphery of the nodular profilesserved as a clue to the diagnosis of PRN. The palisading arrangement of the mononuclearcells was evident only in those foci with central necrobiosis. A histiocytic disorder orfibrohistiocytic process was a common consideration in the differential diagnosis, especiallyin those cases with less apparent foci of necrosis.We histopathologically reported subcutaneous pseudorheumatoid nodules in a 3-years oldhealthy boy with eyelid and eyebrow multiple subcutaneous nodules, without any systemicdiseases.Therefore, Pseudorheumatoid nodules must be included in the differential diagnosis of ocularadnexal lesions that may concomitantly involve the eyelid, orbit, episclera, and periocularregion.