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{{Rheumatoid arthritis}} | {{Rheumatoid arthritis}} | ||
{{CMG}} {{CZ}} | {{CMG}}; {{AE}} {{CZ}} | ||
==Case #1== | |||
====Clinical Summary==== | ====Clinical Summary==== | ||
A 57-year-old white female had suffered from rheumatoid arthritis for 20 years. During this period, many joints were involved, some seriously. Because of the severe pain of this arthritis the patient was placed on steroids and was given analgesics, some of which contained [[acetaminophen]]. The patient also took additional analgesics ([[aspirin]] and/or [[acetaminophen]]) to help control the pain. The patient was admitted to the emergency room for [[weakness]] and [[hematemesis]]. On admission the patient's [[hematocrit]] was 21%. Endoscopy demonstrated a large bleeding ulcer and fresh blood in the stomach and proximal duodenum. The sites of bleeding were cauterized; however, shortly after the procedure the patient became hypotensive and died despite aggressive resuscitation. | A 57-year-old white female had suffered from rheumatoid arthritis for 20 years. During this period, many joints were involved, some seriously. Because of the severe pain of this arthritis the patient was placed on steroids and was given analgesics, some of which contained [[acetaminophen]]. The patient also took additional analgesics ([[aspirin]] and/or [[acetaminophen]]) to help control the pain. The patient was admitted to the emergency room for [[weakness]] and [[hematemesis]]. On admission the patient's [[hematocrit]] was 21%. Endoscopy demonstrated a large bleeding ulcer and fresh blood in the stomach and proximal duodenum. The sites of bleeding were cauterized; however, shortly after the procedure the patient became hypotensive and died despite aggressive resuscitation. | ||
====Autopsy Findings==== | ====Autopsy Findings==== | ||
There were numerous erosions and ulcers in the gastrointestinal tract and a large quantity of fresh blood in the gastrointestinal tract. There was also significant swelling and deformation in multiple joints. On the medial aspect of the right foot there was a firm, irregular, rubbery subcutaneous nodule measuring 2 x 1.5 cm. The cut surface was whitish-yellow and fibrous. | There were numerous erosions and ulcers in the gastrointestinal tract and a large quantity of fresh blood in the gastrointestinal tract. There was also significant swelling and deformation in multiple joints. On the medial aspect of the right foot there was a firm, irregular, rubbery subcutaneous nodule measuring 2 x 1.5 cm. The cut surface was whitish-yellow and fibrous. | ||
====Histopathological Findings==== | ====Histopathological Findings==== | ||
[[Image:RA 001.jpg|left|thumb|400px|This is a gross photograph of the patient's hands at autopsy. Note the swollen joints and the deforming arthritis.]] | [[Image:RA 001.jpg|left|thumb|400px|This is a gross photograph of the patient's hands at autopsy. Note the swollen joints and the deforming arthritis.]] | ||
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[[Image:RA 009.jpg|left|thumb|400px|This is a high-power photomicrograph of another region with macrophages (right), fibrocytes (left), and occasional lymphocytes throughout the lesion. ]] | [[Image:RA 009.jpg|left|thumb|400px|This is a high-power photomicrograph of another region with macrophages (right), fibrocytes (left), and occasional lymphocytes throughout the lesion. ]] | ||
<br clear="left"/> | <br clear="left"/> | ||
==Sources== | |||
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Needs overview]] | |||
[[Category:Aging-associated diseases]] | |||
[[Category:Arthritis]] | |||
[[Category:Autoimmune diseases]] | |||
[[Category:Diseases involving the fasciae]] | |||
[[Category:Rheumatology]] | |||
{{WH}} | |||
{{WS}} | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Case #1
Clinical Summary
A 57-year-old white female had suffered from rheumatoid arthritis for 20 years. During this period, many joints were involved, some seriously. Because of the severe pain of this arthritis the patient was placed on steroids and was given analgesics, some of which contained acetaminophen. The patient also took additional analgesics (aspirin and/or acetaminophen) to help control the pain. The patient was admitted to the emergency room for weakness and hematemesis. On admission the patient's hematocrit was 21%. Endoscopy demonstrated a large bleeding ulcer and fresh blood in the stomach and proximal duodenum. The sites of bleeding were cauterized; however, shortly after the procedure the patient became hypotensive and died despite aggressive resuscitation.
Autopsy Findings
There were numerous erosions and ulcers in the gastrointestinal tract and a large quantity of fresh blood in the gastrointestinal tract. There was also significant swelling and deformation in multiple joints. On the medial aspect of the right foot there was a firm, irregular, rubbery subcutaneous nodule measuring 2 x 1.5 cm. The cut surface was whitish-yellow and fibrous.
Histopathological Findings
