RHEUMATOID PAPULES IN A PATIENT WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME AND SYMMETRICAL POLYARTHRITIS

We describe a patient with acquired immunodeficiency syndrome (AIDS) a nd an unusual rheumatoid factor-positive symmetric inflammatory polyar thritis who met all 7 American College of Rheumatology criteria for RA , but who also had many features suggestive of seronegative inflammato ry arthritis. Although cutaneous vasculitis has also been described in human immunodeficiency virus infection, this is the first report of c utaneous extravascular necrobiotic granuloma (rheumatoid papule) in AI DS. This case highlights the immunopathogenesis of inflammatory arthri tis in AIDS and illustrates the difficulties in making a classic rheum atic diagnosis in the setting of the immune dysregulation caused by AI DS.