Clinic of Dermatology and Venereology, University Clinical Center of Serbia, Belgrade, Serbia University of Belgrade, Faculty of Medicine, Department of Dermatology and Venereology, Belgrade, Serbia.
Dermatol Online J. 2023 Oct 15;29(5). doi: 10.5070/D329562404.
Generalized perforating granuloma annulare (GPGA) is a very rare form of granuloma annulare, with only 31 reported cases to the best of our knowledge. Furthermore, GPGA is a chronic disease that mimics many diseases, with no known exact etiology, resulting in a lack of specific clinical criteria leading to a lack of guidelines for diagnosis and therapy. In GPGA, papules are the predominant lesions followed by central crusting/scaling or umbilication; pustules, plaques, annular lesions or nodules are less frequent. We report a 66-year-old woman who presented with a 7-month history of mostly asymptomatic generalized infiltrated, flesh-colored to red-brown umbilicated or crusted papules. Histopathological findings were compatible with perforating granuloma annulare. Diagnostic workup revealed latent tuberculosis. To the best of our knowledge, this is the second published case of GPGA associated with latent tuberculosis and the first one that was successfully treated by isoniazid monotherapy. From our case we can speculate and support the theory that GPGA is a phenotypic granulomatous response to multiple etiologies and/or antigenic stimulation and that testing for tuberculosis should be seriously considered in the evaluation of patients with GPGA.
广义穿凿性环状肉芽肿（GPA）是环状肉芽肿的一种非常罕见的形式，据我们所知，仅有 31 例报告。此外，GPA 是一种慢性疾病，模仿许多疾病，病因不明，导致缺乏特定的临床标准，从而缺乏诊断和治疗的指南。在 GPA 中，丘疹是主要的病变，其次是中央结痂/脱屑或脐状；脓疱、斑块、环状病变或结节则较少见。我们报告了一位 66 岁女性，她因 7 个月的无症状性全身性浸润性、肉色至红棕色脐状或结痂丘疹就诊。组织病理学发现符合穿凿性环状肉芽肿。诊断性检查显示潜伏性结核病。据我们所知，这是第二例与潜伏性结核病相关的 GPA 病例，也是首例成功用异烟肼单药治疗的病例。从我们的病例中，我们可以推测并支持 GPA 是对多种病因和/或抗原刺激的一种表型肉芽肿反应的理论，并且在评估 GPA 患者时应认真考虑结核病检测。
