case of granuloma faciale

A 60-year-old housewife reported with a raised red lesion on the left cheek since the last four months. Local examination revealed a well-defined erythematous indurated plaque 3x3 cm[2] with geographical borders on the left cheek close to the angle of mouth. Routine investigations were normal. Histopathology revealed loosely scattered granulomas in the dermis with lymphocytes, plasma cells, neutrophils and eosinophils. A disease free Grenz zone was seen. A diagnosis of granuloma faciale was made and the patient was put on intralesional steroid therapy. She continues to be on regular follow up

Systemic amyloidosis presenting as mucocutaneous bullous lesions

A 65-year-old male presented with hemorrhagic bullous skin lesions with purpura and ecchymoses. There was increased skin fragility with a strongly positive Nikolsky sign. Histopathology of the skin revealed large amounts of amyloid deposits in the dermis with a positive Congo Red staining around the dermal vessels. Examination and tests in this patient also revealed anemia, hepatomegaly, infiltrative cardiomyopathy, polyneuropathy and immunoglobulin lamda deposition, favoring a diagnosis of primary amyloidosis [AL type]. The present case is reported in view of the rarity of the bullous variant of primary systemic amyloidosis as well as presence of mucosal lesions and a positive Nikolsky sign