Chronic active hepatitis presenting with rheumatoid nodules and arthritis.

Chronic active hepatitis is often accompanied by extrahepatic rheumatic symptoms of mild or moderate severity. We report a 16-year-old girl with this disorder who presented with severe polyarthritis and rheumatoid nodules mimicking juvenile rheumatoid arthritis. Rheumatoid nodules have not previously been described in chronic active hepatitis, and the severity of the rheumatic symptoms in our patient led to a delay in the recognition of the underlying liver disease. Our report provides support for an autoimmune etiology in some patients with chronic active hepatitis, notes the occurrence of rheumatoid nodules in the disorder, and emphasizes that severe extrahepatic symptoms may obscure the diagnosis and institution of therapy in some individuals.