Case 1

A 67-year-old man presents with 2 nodules on his elbow. He has never had any skin conditions but 2 years previously was diagnosed with rheumatoid arthritis, which he manages with methotrexate and nonsteroidal anti-inflammatory drugs. The nodules are uncomfortable and aesthetically displeasing, but they are not painful. On examination, 2 large, firm, skin-colored subcutaneous nodules on the elbow are noted. Biopsy is performed, revealing palisading necrobiotic granuloma and a central area of fibrin in the deep dermis.

Can you diagnose the condition in Case 1?

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A. Fibromas
B. Nodular scleroderma
C. Subcutaneous granuloma annulare
D. Rheumatoid nodules

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