Pediatric Section, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
Pediatric Unit, A.O. Santa Maria Terni, 05100 Terni, Italy.
Int J Environ Res Public Health. 2019 Jul 11;16(14):2471. doi: 10.3390/ijerph16142471.
: Idiopathic facial aseptic granuloma (IFAG) is a rare skin disease that typically presents in children with one or more nontender, erythematous to violaceous nodules located on the cheeks or eyelids. Lesions are not accompanied by other skin abnormalities. IFAG remains a diagnostic challenge in pediatric dermatology, because several diseases may present with similar signs. : A three-year-old girl with a previous negative clinical history was referred to our hospital for the evaluation of some asymptomatic nodules on the convexity of the left cheek. The nodules had appeared two months before, and had gradually increased in size. Her mother denied any association with trauma or insect bites. The nodules had a hard-elastic consistency, were moderately firm, and were not fluctuant. No associated lymphadenopathy was observed. The girl was afebrile and in good general condition. A histologic evaluation of a biopsy specimen revealed an inflammatory, granulomatous-diffuse infiltrate in the superficial and deep dermis consisting of giant cells, histiocytes, lymphocytes, neutrophils, eosinophils, and plasma cells. The Ziehl-Neelsen stains, Gram-stains, and cultures were negative. Suspecting an IFAG, treatment with topical fusidic acid and oral clarithromycin for 14 days was started. After two months, the lesion resolved and did not recur. : This case shows how to differentiate IFAG from other dermatologic diseases associated with a negative evolution. Treatment with oral clarithromycin was effective in our patient. However, more scientific evidence is needed to evaluate the most suitable antibiotic therapy. Further studies are also needed to establish whether antibiotics actually impact IFAG prognosis.
特发性面部无菌性肉芽肿（IFAG）是一种罕见的皮肤病，通常发生在儿童身上，表现为一个或多个无触痛的、红斑至紫色的结节，位于脸颊或眼睑。病变不伴有其他皮肤异常。IFAG 在儿科皮肤病学中仍然是一个诊断挑战，因为几种疾病可能具有相似的表现。
一名 3 岁女孩，既往临床病史阴性，因左脸颊凸面的一些无症状结节就诊于我院。这些结节两个月前出现，逐渐增大。她的母亲否认与外伤或昆虫叮咬有关。结节质地坚硬有弹性，中等硬度，无波动感。未观察到相关淋巴结病。患儿无发热，一般情况良好。活检组织学评估显示，真皮浅层和深层存在炎症性、肉芽肿性弥漫性浸润，由巨细胞、组织细胞、淋巴细胞、中性粒细胞、嗜酸性粒细胞和浆细胞组成。Ziehl-Neelsen 染色、革兰氏染色和培养均为阴性。考虑 IFAG，开始给予外用夫西地酸和口服克拉霉素治疗 14 天。两个月后，皮损消退，未再复发。
本病例展示了如何将 IFAG 与其他皮肤科疾病相区别，这些疾病具有不良的演变过程。在我们的患者中，口服克拉霉素治疗有效。然而，需要更多的科学证据来评估最合适的抗生素治疗。还需要进一步的研究来确定抗生素是否真的会影响 IFAG 的预后。
