TY - JOUR T1 - Unusual Draining Nodules in a Patient with Rheumatoid Nodulosis and Hepatitis C Virus Infection JF - The Journal of Rheumatology JO - J Rheumatol SP - 1806 LP - 1808 DO - 10.3899/jrheum.110244 VL - 38 IS - 8 AU - HONGYAN WEN AU - H. RALPH SCHUMACHER AU - SALLY W. PULLMAN-MOOAR AU - EUGENE EINHORN Y1 - 2011/08/01 UR - http://www.jrheum.org/content/38/8/1806.abstract N2 - To the Editor:Rheumatoid nodulosis is an uncommon condition with a combination of multiple rheumatoid nodules, recurrent joint symptoms, but without erosions, and usually positive tests for rheumatoid factor (RF). We describe a case of rheumatoid nodulosis with followup exceeding 10 years. The nodules first developed during treatment for hepatitis C virus (HCV) infection with interferon (IFN). A nodule biopsy confirmed the presence of a rheumatoid nodule. This association of draining nodules, rheumatoid nodulosis, and HCV is rare and raises the possibility that it might have been precipitated by the IFN therapy.A 53-year-old man presented with an 11-year history of hepatitis C and a 10-year history of poorly characterized asymmetrical arthritis and nodules. In February 1999, he was diagnosed elsewhere with hepatitis C based on laboratory tests and started therapy with ribavirin/α-IFN. After 1 year, he stopped ribavirin/α-IFN due to absence of effect on the viral load and did not follow up with his hepatologist.In August 1999, multiple subcutaneous nodules developed on his fingers. The nodules would gradually enlarge, discharge necrotic-appearing material, and then develop a central crater and at that time became painful. In January 2001, aspiration of one of the nodules was negative for crystals. A large finger nodule mass with dimensions 3.0 × 2.5 × 1.0 cm was excised for biopsy. Some individual nodules were injected with intralesional depot methylprednisolone, with complete resolution, but he continued to develop new nodules. Nonsteroidal antiinflammatory drugs (NSAID) helped his occasional pain from draining nodules, but did not change the shape or size of the nodules. Accompanying the nodules, he experienced intermittent joint pain and swelling that involved proximal interphalangeal joints, wrists, shoulders, and elbows. The joint pain improved under treatment with hydroxychloroquine but the nodules persisted. Due to anxiety over side effects he stopped hydroxychloroquine after 6 months. … Address correspondence to Dr. Schumacher; E-mail: schumacr{at}mail.med.upenn.edu ER -