Cutaneous granulomas in children with combined immunodeficiency.

Noninfectious cutaneous granulomas, particularly in an acral distribution, may be an early sign of mixed cellular and humoral immunodeficiency. Special stains of skin biopsy sections and cultures for bacteria, acid-fast bacilli, and fungi are important in eliminating the possibility of underlying pathogens. In three children with combined immunodeficiency and cutaneous granulomas, the administration of moderate- to high-dose systemic corticosteroids was the most effective therapy. However, careful consideration should be given before administering systemic corticosteroids to an immunocompromised patient.