Fisk Whitney A, Millsop Jillian W, Johnson Mary Ann, Konia Thomas H, Fung Maxwell A, Sharon Victoria R
University of California, Davis, Sacramento.
Dermatol Online J. 2015 Sep 17;21(9):13030/qt5tp738q9.
Granuloma annulare is typically a benign, self-limited disease. Atypical presentations have been reported in association with systemic disease, including malignancy. Such patients may require additional diagnostic studies to assess for underlying malignancy. We report a patient with extensive sporotrichoid granuloma annulare-like dermatitis in association with systemic B-cell lymphoma.
An 83-year-old man with a three-year history of progressive sporotrichoid annular plaques and nodules on the arm developed ipsilateral retroauricular palpable lymphadenopathy, the latter consistent with B-cell lymphoma. Multiple skin biopsies of the plaques and nodules revealed granuloma annulare-like dermatitis. Lesions were unresponsive to intralesional and intramuscular corticosteroids, antibiotics, and antifungal agents, but rapidly improved following initiation of rituximab to treat his underlying lymphoma.
Atypical presentations of granuloma annulare including granuloma annulare-like dermatitis warrant evaluation for systemic malignancy in a subset of patients.
环状肉芽肿通常是一种良性的自限性疾病。有报道称非典型表现与包括恶性肿瘤在内的全身性疾病有关。此类患者可能需要额外的诊断性检查以评估潜在的恶性肿瘤。我们报告了一名患有广泛的孢子丝菌样环状肉芽肿样皮炎并伴有全身性B细胞淋巴瘤的患者。
一名83岁男性，手臂上有三年渐进性孢子丝菌样环状斑块和结节病史，出现同侧耳后可触及的淋巴结肿大，后者与B细胞淋巴瘤相符。对斑块和结节进行的多次皮肤活检显示为环状肉芽肿样皮炎。病变对皮损内和肌肉注射皮质类固醇、抗生素及抗真菌药物均无反应，但在开始使用利妥昔单抗治疗其潜在淋巴瘤后迅速改善。
环状肉芽肿的非典型表现，包括环状肉芽肿样皮炎，在一部分患者中需要评估是否存在全身性恶性肿瘤。
