81-year-old woman with a long history of rheumatoid arthritis (RA) was treated for ten years with methotrexate (25 mg/week) and prednisone (5 mg/day), and for one year in 2010 with monthly infusions of Remicade. She presented with a palpable abnormality in the right neck. A CT scan showed a 3.1 cm x 2.7 cm x 2.2 cm dominant hypodense mass with a thickened rim of soft tissue that was adherent to the right submandibular gland. A draining fistula in the right neck with surrounding erythema was noted, with the overlying skin was adherent to the mass and inflammation. During surgery, the entire area adjacent to the mass was involved by extensive inflammation and granulation tissue.