Cutaneous Granulomas presenting as skin nodules are the most common extra-articular manifestation of rheumatoid arthritis. Granulomas are defined as a form of chronic inflammatory response characterised by aggregation of activated histiocytes. Visceral granulomas are a rare complication of long-standing rheumatoid arthritis and their occurrence in the pancreas was previously described in only two case reports. We report a case of a 55-year-old woman with a 15-year history of rheumatoid arthritis. The patient presented with epigastric pain and weight loss. Imaging studies showed a large soft tissue mass in the head of the pancreas which was suspected to be malignant. A Whipple procedure was performed, and histological examination revealed multiple non-caseating granulomas with central liquefaction and neutrophilic infiltrate. Ziehl-Neelsen stain for acid-fast bacilli and tuberculosis polymerase chain reaction were negative. The patients’ granulomas were diagnosed as rheumatoid granulomas. Five years after diagnosis, the patient is doing well and has no complications.

Cutaneous Granulomas presenting as skin nodules are the most common extra-articular manifestation of rheumatoid arthritis. Granulomas are defined as a form of chronic inflammatory response characterised by aggregation of activated histiocytes. Visceral granulomas are a rare complication of long-stan...