Interstitial granulomatous dermatitis: a rare case report of dermatological manifestation of rheumatoid arthritis

Interstitial granulomatous dermatitis (IGD), a rare dermatological disorder was first described by Ackerman et al, in the year 1993. It is characterized by a heterogeneous clinical spectrum and a specific histopathological pattern. It has been described in association with a number of auto-immune disorders, drugs, fungal infections, and malignancies. It may manifest as papules, patches, plaques, nodules, annular lesions, or less frequently, as described classically, as indurated linear subcutaneous cords. This case is being reported as interstitial granulomatous dermatitis is rare dermatological manifestation of rheumatoid arthritis and presentation as large ulcerated skin lesions is further extremely rare. In this case report we describe a 67-year-old gentleman with Seropositive Rheumatoid arthritis. He presented to our hospital with complaints of multiple well defined skin lesions with pus discharge over lower limbs, trunk and upper limbs. Biopsies from left upper limb and abdomen showed focal necrobiosis with surrounding granulomatous inflammation with rare perivascular granulomas. He was subsequently diagnosed to have interstitial granulomatous dermatitis based on histopathological examination. Interstitial granulomatous dermatitis has been described to be associated with a number of autoimmune conditions and drugs. It is very important for clinicians to have knowledge about this rare skin condition as it may be heralding presentation of a serious underlying condition like lymphoproliferative disorders or solid organ malignancies. There is no specific treatment and causative disease has to be diagnosed and targeted.

Palisaded Encapsulated Neuroma Occuring at the Previous Excision Site of Epidermal Cyst on the Scalp / 대한피부과학회지

No abstract available.

A Case of Palisaded Neutrophilic and Granulomatous Dermatitis Treated with Dapsone / 대한피부과학회지

No abstract available.

Palisaded Neutrophilic and Granulomatous Dermatitis Manifested as a LE-nonspecific Skin Lesion / 대한피부과학회지

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a newly defined entity that includes various clinical entities. Histopathologically, this disease is characterized by a granulomatous inflammation with or without leukocytoclastic vasculitis. PNGD shows vasculitic lesions in the early stage, with palisaded granulomatous lesions and dermal fibrosis with minimal leukocytoclastic debris appearing in the late stage. It is frequently associated with rheumatoid arthritis, lupus erythematosus, and other autoimmune diseases. A 14-year old Korean girl presented with multiple erythematous nodules and plaques on both elbows and knees that were present for 2 years prior to the initial visit. Clinically, she had multiple arthritis with morning stiffness and decreased C3 levels, as well as positive results for antinuclear antibodies, the lupus anticoagulant test, and anti-beta 2 glycoprotein I (IgG). Skin biopsy findings from the skin lesion indicated that the foci of degenerated collagens were palisaded with histiocytes throughout the dermis and neutrophils with leukocytoclasia infiltrated with fibrin, with mucin at the center of the lesion. Based on the SLICC 2012 criteria, we diagnosed her condition as PNGD in systemic lupus erythematosus. She was treated with hydroxychloroquine and topical application of 0.1% tacrolimus ointment, which resulted in the remarkable flattening of the skin lesions after 6 months of follow-up. Herein, we report a case of PNGD that may have been an indicator of systemic lupus erythematosus.

A Case of Painful Palisaded Encapsulated Neuroma of the Foot / 대한피부과학회지

No abstract available.

Abrupt Onset of Palisaded Neutrophilic and Granulomatous Dermatitis in a Patient with Rheumatoid Arthritis / 대한피부과학회지

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is characterized histopathologically by the presence of granulomatous inflammation with or without leukocytoclastic vasculitis. It has been associated with multiple systemic diseases, particularly autoimmune conditions like rheumatoid arthritis and Behcet's disease. We report a 52-year-old woman with rheumatoid arthritis who presented with a single, non-tender, rapidly growing nodule on her right elbow. Histologic examination of the nodule revealed degenerated collagen, neutrophils, neutrophilic dust, fibrin, and mucin present in the centers of the palisades of histiocytes throughout the dermis. Herein, we report the abrupt onset of PNGD in a patient with rheumatoid arthritis.

Palisaded Encapsulated Neuroma with Unusual Clinical Features: 1 Case / 대한피부과학회지

Palisaded encapsulated neuroma (PEN) is a rare, benign, cutaneous nerve sheath tumor, which usually appears as a solitary asymptomatic skin-colored papule, which usually affects the face of middle-aged adults. Here, we report a case of PEN with unusual clinical features in a 23-year-old female, developed on the back, accompanied with pain sensation. Histopathologically, it appeared as a well-circumscribed, encapsulated round nodule, consisted of uniform, broad, and interlacing fascicles of the spindle cells in the dermis. On immunohistochemical staining, the tumor cells of nodule were positive for S-100 protein and neural filaments, while the capsule of the nodule was focally positive for the epithelial membrane antigen.

A Case of Plexiform Palisaded Encapsulated Neuroma of the Penis / 대한피부과학회지

Palisaded encapsulated neuroma (PEN) is a benign cutaneous neural tumor. It usually presents in adults as a solitary asymptomatic skin-colored papule that is almost always on the face. We report here on an uncommon case of plexiform PEN that developed on the penis of a 43-year-old man. It was 6 mm-sized skin colored papule. Histologically, there is an encapsulated nodule with a plexiform growth pattern in the dermis and a palisading arrangement of nuclei. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 and neurofilament.

A Case of Palisaded Neutrophilic and Granulomatous Dermatitis on the Buttock / 대한피부과학회지

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon condition that has been reported under several different names in association with various disorders such as rheumatoid arthritis and systemic lupus erythematosus. We report a 60-year-old man with rheumatoid arthritis who presented with two, erythematous, asymptomatic nodules on the buttock. The histologic examination showed that degenerated collagen, neutrophilic dust, neutrophils, fibrin, and mucin were present in the centers of the palisades of histiocytes throughout the dermis. After initiation of intralesional steroid injections, the lesions improved. The lesions recurred 2 months later, but, as before, improved after treatment with intralesional steroid injections.

A Case of Palisaded Neutrophilic and Granulomatous Dermatitis / 대한피부과학회지

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon skin eruption associated with immune-mediated connective tissue diseases such as rheumatoid arthritis, lupus erythematosus, and Behcet's disease. This condition is also described as Winkelmann's granuloma, linear subcutaneous bands, rheumatoid papules, rheumatoid neutrophilic dermatitis, interstitial granulomatous dermatitis with cutaneous cords and arthritis, or Churg-Strauss disease. PNGD shows variable clinical manifestations and is characterized histopathologically by step pattern of early leukocytoclastic vasculititis, progressing to form palisaded granulomatous inflammation, and surrounding zones of necrobiosis in the later stages. We report a 66-year-old woman with multiple skin nodules, who had concomitant rheumatoid arthritis. Histopathologic findings revealed palisaded neutrophilic and granulomatous dermatitis.

A Case of Palisaded Neutrophilic and Granulomatous Dermatitis (Rheumatoid Papule) / 대한피부과학회지

Palisaded neutrophilic and granulomatous dermatitis is a newly described disease associated with connective tissue disorders, such as rheumatoid arthritis or lupus erythematousus. Cases associated with rheumatoid arthritis are also termed rheumatoid papules. We report a 27-year-old woman who presented with two erythematous, tender papules on her left elbow. She had rheumatoid arthritis and was being treated with an oral steroid, methotrexate and nonsteroidal antiinflammatory drugs. Histopathologic examination showed degenerative collagen with basophilic fibrinoid materials and neutrophils surrounded by palisaded epithelioid cells in the upper dermis.

A Case of Palisaded Neutrophilic Granulomatous Dermatitis in Rheumatoid Arthritis / 대한피부과학회지

Palisaded neutrophilic granulomatous dermatitis (PNGD) is an unusual entity that has been described under several different names including, linear subcutaneous bands, interstitial dermatitis with cutaneous cords and arthritis, rheumatoid papules and Churg-Strauss granuloma. The condition is seen in patients with rheumatoid arthritis and other connective tissue diseases. PNGD shows variable clinical manifestations and represents a histologic spectrum, starting with early vasculitic lesions, then palisaded granulomatous lesions and dermal fibrosis with minimal leukocytoclastic debris in the late stage lesions. We report an unusual case of a 49-year old woman with rheumatoid arthritis who presented with multiple acral nodules. The histologic examination revealed palisaded neutrophilic granulomatous dermatitis.

A Case of Palisaded Encapsulated Neuroma of the Lower Lip

Palisaded encapsulated neuroma (PEN) is a clinically-distinctive, benign, cutaneous nerve sheath tumor. It usually occurs as a solitary, asymptomatic, skin-colored papule, and commonly affects the face of middle-aged adults. We report a case of PEN which developed on the lower lip of a 44-year-old Korean man. It was a 5mm-sized skin colored papule. Histopathologically, it consisted of uniform, broad, interlacing fascicles of spindle cells and was surrounded by a complete capsule in the dermis. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 protein and neural filaments, whil the capsule of the nodule was positive for epithelial antigen.

A Case of Palisaded Encapsulated Neuroma of the Eyelid / 대한피부과학회지

Palisaded encapsulated neuroma (PEN) is a rare intraneural neuroma. It usually occurs as a solitary asymptomatic skin-colored papule, and commonly affects the butterfly area of the face of middle-aged adults. We report a case of PEN which developed on the right upper eyelid of a 30-year-old man. It was a 3 mm-sized skin colored papule, and histologically, there was a well- defined encapsulated nodule in the dermis, composed of spindle cells with basophilic and plump nuclei in a palisading pattern. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 protein, while the capsule of the nodule was positive for epithelial membrane antigen.

A Case of Palisaded Encapsulated Neuroma of the Lower Lip / 대한피부과학회지

Palisaded encapsulated neuroma(PEN) is a rare intraneural neuroma. It usually occurs as a solitary, asymptomatic, skin-colored papule, and commonly affects the butterfly area of the face of middle-aged adults. However, it rarely involves oral mucosa including lip and should be differentiated from mucosal neuromas which generally occur as multiple small nodules of the lips and the anterior part of the tongue. We report a case of PEN occurring on the lower lip in a 33-year-old male. Histopathologically, it appeared as a well-circumscribed, encapsulated round nodule in the dermis. The nodule was composed of well-developed fascicles of wavy spindle cells separated by a loose matrix. Nuclear palisades were ill defined. On immunohistochemical staining, most tumor cells of the nodule were positive for S-100 protein and about 30% of tumor cells were positive for neural filament, but the capsule was negative for them. Epithelial membrane antigen was focally and discontinuously reactive on the capsule of the nodule.

A Case of Granuloma Faciale Showing Unusual Histopathological findings

Granuloma faciale is an uncommon localized form of small-vessel vasculitis characterized by single or multiple lesions on the face in middle-aged whites, especially males. Histopathological examination demonstrates a dense polymorphous cellular infiltrate consisting of neutrophils, eosinophils, lymphocytes and histiocytes in the upper two thirds of the dermis. A characteristic subepidermal Grenz zone separates the infiltrate from the epidermis. We report a case of granuloma faciale, showing interesting evidence of palisaded granuloma-like pattern in the serial biopsy specimen at 3-year interval.

A Case of Palisaded Encapsulated Neuroma / 대한피부과학회지

Palisaded encapsulated neuroma is a primary hyperplasia of Schwann cell and axon nerve fiber. It is characterized clinically by a solitary, slowly-growing and dome-shaped papule or nodule, and histopathologically by encapsulated nodule in the dermis and the palisading arrangement of nuclei. We report a case of palisaded encapsulated neuroma which had developed in the face of a 22-year-old female over the course of about 6months. Histopathological findings showed a well-demarcated intradermal nodule and its capsule. The nodule is composed of spindle cell with prominat basophilic nuclei and little cytoplasm in a palisading fashion. We report a case of palisaded encapsulated neuroma with a review of the literature.

A Case of Palisaded Encapsulated Neuroma / 대한피부과학회지

Palisaded encapsulated neuroma is a benign neural tumor located almost exclusively on the face of middle-aged adults. We report a case of palisaded encapsulated neuroma which developed on the upper lip of a 45-year-old man. Clinically, the lesion was asymptomatic, solitary, dome-shaped, pink papule. Histologically, there was a well-demarcated dermal nodule composed of fascicles of Schwann cells. On Bielschowsky staining, numerous axons were observed.

A Case of Palisaded Encapsulated Neuroma / 대한피부과학회지

Palisaded encapsulated neuroma is a benign neural tumor located almost exclusively on the face of middle-aged adults. We report a case of palisaded encapsulated neuroma which developed on the upper lip of a 45-year-old man. Clinically, the lesion was asymptomatic, solitary, dome-shaped, pink papule. Histologically, there was a well-demarcated dermal nodule composed of fascicles of Schwann cells. On Bielschowsky staining, numerous axons were observed.

A Case of palisaded, Encapsulated Neuroma / 대한피부과학회지

Palisaded, encapsulated neuroma is characterized clinically by a solitary, slowly-growing and dome-shaped papule or nodule, usually accompanied by telangiectasia on the surface, and histopathologically by an encapsulated nodule in the dermis and the palisading arrangement of nuclei. A 57-year-old female patient presented with a 1cm-sized, solitary nodule on the right ala nasi which had been present for about 5 years. The nodule had a tendency to slow growth and it became a polypoid nodule. Telangiectasia was shown on the surface of the lesion. Histopathlogical findings showed a well-defined and encapsulated nodule in the dermis, composed of spindle cells with basophilic and plump nuclei in a palisading fashion. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 protein, while the capsule of the nodule was negative for S-100 protein. Epithelial membrane antigens were focally positive only on the capsule of the nodule. We report herein a case of palisaded, encapsulated neuroma, one case of which has been reported in Korea.