Phoenix VA Health Care System, Phoenix, USA.
The University of Arizona College of Medicine, Phoenix, USA.
J Med Case Rep. 2024 Jun 20;18(1):299. doi: 10.1186/s13256-024-04598-w.
Granuloma annulare is a noninfectious inflammatory granulomatous skin disease characterized by an erythematous or skin colored annulare plaque. The diagnosis of granuloma annulare may be challenging owing to its diverse morphology. In such cases, a correlation between the clinical findings and histologic findings are necessary.
We report a case of granuloma annulare after purified protein derivative administration. A 56-year-old Caucasian female patient complained of mildly pruritic rashes which started on both arms and lower extremities, and eventually spread to both thighs, the left popliteal region, left upper back, and the right abdominal area. About 6 weeks prior to the eruption of the rashes, the patient had been given a purified protein derivative tuberculin skin test. Biopsy specimens revealed dermal histiocytes palisading around areas of mucin and degenerated collagen, confirming granuloma annulare. After treatment with 0.1% topical triamcinolone acetanide and 500 mg oral metronidazole, the patient's lesions resolved.
Relatively little is known about granuloma annulare's exact etiology. Granuloma annulare has four variations presenting as either localized, generalized, subcutaneous, or perforating and patch granuloma annulare. The clinical prognosis for granuloma annulare varies according to clinical subtypes. Proposed causal mechanisms of subcutaneous granuloma annulare include physical trauma, infections, immunizations, insect bites, diabetes mellitus, and alterations in the cell-mediated immune responses. The disease likely has an inflammatory component. Clinically, granuloma annulare may be confused with many other skin diseases.
This case of subcutaneous granuloma annulare was reported since it is a rare dermatologic pathological condition that can be confused with other skin rash disorders. Although it is a benign self-limited disease, definitive diagnosis is important to rule out other pathologies with similar clinical appearances, such as cancer or human immunodeficiency virus (HIV) infection. Diagnostic confirmation is best made through skin biopsy.
环状肉芽肿是一种非传染性炎症性肉芽肿性皮肤病，其特征为红斑或皮肤色环状斑块。由于其形态多样，环状肉芽肿的诊断可能具有挑战性。在这种情况下，临床发现与组织学发现之间存在相关性是必要的。
我们报告了一例在纯化蛋白衍生物给药后发生的环状肉芽肿病例。一名 56 岁的白种女性患者抱怨手臂和下肢出现轻度瘙痒性皮疹，最终扩散至大腿、左腘窝、左背部和右腹部。在皮疹发作前约 6 周，患者接受了纯化蛋白衍生物结核菌素皮肤试验。活检标本显示真皮组织细胞围绕粘蛋白和变性胶原形成的栅栏状排列，证实为环状肉芽肿。给予 0.1%外用曲安奈德和 500mg 口服甲硝唑治疗后，患者的皮损消退。
关于环状肉芽肿的确切病因知之甚少。环状肉芽肿有四种变异型，表现为局限性、全身性、皮下型或穿孔和斑块状环状肉芽肿。环状肉芽肿的临床预后根据临床亚型而异。皮下型环状肉芽肿的发病机制包括物理性创伤、感染、免疫接种、昆虫叮咬、糖尿病和细胞介导免疫反应的改变。该疾病可能具有炎症成分。临床上，环状肉芽肿可能与许多其他皮肤病混淆。
报道了这例皮下型环状肉芽肿病例，因为它是一种罕见的皮肤科病理状况，可能与其他皮疹疾病混淆。尽管它是一种良性自限性疾病，但明确诊断很重要，以排除具有相似临床表现的其他病理情况，如癌症或人类免疫缺陷病毒（HIV）感染。通过皮肤活检可做出明确诊断。
