Rheumatoid granuloma of the cervix and vagina: a challenging diagnosis and treatment.

Abstract

Granulomas of the female genital tract are rare and usually occur after operative procedures. A patient with rheumatoid arthritis presented with vaginal discharge and bleeding with ulcerative, red, friable lesions of the cervix, which extended to the bladder floor and the right upper vaginal wall. Cervical biopsy was highly suggestive of rheumatoid nodules. This prompted revision of the diagnosis of tuberculosis, which was suspected several months earlier when pulmonary and renal lesions were noted. The cervico-vaginal lesions did not respond to local steroid treatment and improved when the systemic steroid dose was increased; however, they recurred on tapering the dose. Rheumatoid nodules can occur in the genital tract, which poses diagnostic and treatment challenges.