Generalized lymphadenopathy as an atypical initial clinical manifestation in rheumatoid arthritis and a possible hypothetical mechanism

Objective:To describe a 60-year-old male with diffuse generalized lymphadenopathy preceding a diagnosis of rheumatoid arthritis.Case presentation:The patient was admitted on suspicion of lymphoma.Chest positron emission/computed tomography showed enlarged lymph nodes bilaterally,mediastinum in the perihilar,retroperitoneum,and inguinal regions,with normal hematopoiesis of bone marrow.Lymph node biopsy revealed reactive follicular lymphadenopathy.Polyarthritis was present,and a rheumatoid factor test was positive eight months after the initial medical evaluation.A diagnosis of rheumatoid arthritis associated with generalized lymph node involvement was made.The patient was treated with leflunomide and corticosteroids and showed complete recovery without recurrence at 18 months of follow-up.Conclusions:Once histological findings of reactive lymph node hyperplasia are established as primarily related to rheumatic disease activity,clinicians should consider a possible diagnosis of rheumatoid arthritis.