"Pseudorheumatoid" nodules in children.

Subcutaneous nodules which are characterised by central fibrinoid necrosis, surrounded by histiocytes and fibroblasts are traditionally considered to be manifestations of rheumatoid arthritis or rheumatic fever. In recent years, however, cases in which such nodules appeared in otherwise healthy children have been reported. Beatty (1959) reported nine children, aged between eleven days and nine years, with isolated nodules located on the scalp, ulnar aspect of the forearm, palm and dorsum of the foot, who had no manifestations of rheumatic disease. He postulated that these lesions represented an unusual reaction to trauma. Draheim, Johnson and Helwig (1959) reported fifty-seven children between three and six years old with subcutaneous nodules. One patient developed rheumatic fever but none had rheumatoid arthritis. Twenty-five per cent gave a history of injury. They suggested a relationship between the nodules and allergy. Taranta (1962) described nodules in a six-year-old girl, histologically identical to those seen in rheumatic disease; he considered an altered reaction to trauma as a possible cause. Altman and Caffrey (1964) reported similar nodules in two children without systemic disease. Mesara, Brody and Oberman (1966) introduced the term “pseudorheumatoid”, referring to subcutaneous nodules histologically resembling rheumatoid nodules but without evidence of systemic disease; they published ten cases in children and two in adults. None of them had collagen disease or developed it during a period of observation of from one to seventeen years, but after excision seven showed recurrent nodular formations. The authors could not explain the etiology, nor could they differentiate the nodules with certainty from rheumatoid nodules,