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Interstitial granulomatous dermatitis associated with
the use of tumor necrosis factor alpha inhibitors.Arch
Dermatol. 2006 Feb;142(2):198-202.
BACKGROUND:
Tumor necrosis factor alpha (TNF-alpha) has been implicated in the
pathogenesis of numerous inflammatory and autoimmune disorders.
Accordingly, TNF-alpha inhibitors, such as thalidomide, infliximab (Remicade),
adalimumab (Humira), and etanercept (Enbrel), have been used with
success in the treatment of autoimmune disorders, including
psoriasis, rheumatoid arthritis, inflammatory bowel diseases, and
lymphoproliferative disorders. Although anti-TNF-alpha therapy is
safe and well tolerated, various adverse cutaneous reactions have
been reported. OBSERVATIONS: We encountered 5 patients who developed
erythematous annular plaques on the trunk and extremities while
receiving 4 different medications with inhibitory activity against
TNF-alpha. One patient was treated with lenalidomide (Revlimid) for
multiple myeloma, 2 received infliximab, and 1 received etanercept
for severe rheumatoid arthritis; the last patient was in a clinical
trial of adalimumab for psoriatic arthritis. Skin biopsy specimens
revealed diffuse interstitial granulomatous infiltrates of
lymphocytes, histiocytes, and eosinophils, palisading degenerated
collagen. Withdrawal of the medications led to complete resolution
of the skin lesions. CONCLUSION: Interstitial granulomatous
dermatitis should be considered in the differential diagnosis of
skin lesions occurring in the setting of anti-TNF-alpha therapy.
Interstitial
granulomatous dermatitis without arthritis: successful therapy with
hydroxychloroquine.J
Dtsch Dermatol Ges. 2003 Feb;1(2):137-41
Interstitial
granulomatous dermatitis is a rare entity characterized by cutaneous
linear strands (the "rope sign") and rheumatoid arthritis. In the
past years, 12 other cases have been described with variable
cutaneous symptoms. All showed similar histological features,
resembling those of granuloma annulare or 'palisaded neutrophilic
and granulomatous dermatitis', suggesting a wide spectrum for a
single entity. A 60-year-old patient presented with erythematous
patches with an indurated, violaceous border resembling the "rope
sign" on both flanks. The histological investigation revealed dense
diffuse interstitial inflammatory infiltrates composed of
eosinophils, neutrophils, lymphocytes, macrophages and
multinucleated giant cells in the superficial and deep dermis. In
the deep dermis, prominent eosinophilic degenerated collagen fibres
with surrounding macrophages ('floating sign') occurred. In contrast
to most previously described patients, our patient did not have
arthralgias. The skin findings cleared following therapy with
hydroxychloroquine.
Interstitial granulomatous dermatitis secondary to soy.J
Am Acad Dermatol. 2004 Aug;51(2 Suppl):S105-7.
A healthy
58-year-old woman developed an asymptomatic papular eruption of the
neck, cheek, abdomen, arms, and flexures. There was an 8-year
history of the lesions, which had erupted when the patient started a
strict vegetarian diet. Lesions lasted 3 to 5 days, cleared without
scarring, and were associated with burning and increased tearing of
the eyes. The biopsy specimen showed an interstitial granulomatous
dermatitis without vascular injury, collagen alteration, or
mononuclear atypia. The eruption cleared when the patient omitted
soy products from her diet. It subsequently recurred with intake of
even minimal amounts of soy. Interstitial granulomatous dermatitis
is a histologic pattern of inflammation that generates a broad
differential diagnosis. No previous reports of interstitial
granulomatous dermatitis related to soy products are available in
the literature.
Interstitial
granulomatous dermatitis with arthritis.
Hum Pathol.
2004 Jul;35(7):892-4
Interstitial
granulomatous dermatitis with arthritis is an uncommon disorder. In
its original description, the presence of linear inflammatory
indurations on the lateral aspects of the trunk (the rope sign) in
association with arthritis were considered the pathognomonic
clinical features. Later cases presenting with plaques and papules
have been reported. Herein we describe a case of interstitial
granulomatous dermatitis with arthritis without the rope sign. The
present case supports the idea that interstitial granulomatous
dermatitis with arthritis may have variable clinical appearances.
Interstitial
granulomatous dermatitis with plaques and arthritis.Eur
J Dermatol. 2003 May-Jun;13(3):308-10
Interstitial
granulomatous dermatitis (IGD) is a histopathological disorder
characterised by an infiltration of the reticular dermis with a
predominance of interstitial and palisadic histiocytes with a few
areas of degenerating collagen bundles associated with a variable
number of polynuclear neutrophils and eosinophils. There are several
clinical conditions with a pattern of IGD. The linear form
associated with arthritis was the first variety described. There is
also a second form, which presents with plaques. This variety may be
associated with arthritis, use of certain drugs or the presence of
different systemic disorders. We report a case of IGD with plaques
and arthritis. We discuss the differential clinical and histological
diagnosis with other inflammatory skin lesions, which may be
associated with joint disorders and collagen degeneration. We
believe that it should be considered in patients presenting with
arthritis and skin lesions.
Interstitial granulomatous dermatitis with plaques.J
Am Acad Dermatol. 2002 Jun;46(6):892-9.
BACKGROUND:
Interstitial granulomatous dermatitis is a histopathologic pattern
with variable clinical appearance associated with autoimmune
systemic diseases. The frequency of its different cutaneous
expressions and its association with autoimmune diseases are not
known. OBJECTIVE: We describe the clinical, serologic, and
histologic features in 17 patients with interstitial granulomatous
dermatitis with a clinical presentation consisting of large
erythematous plaques. METHOD: Skin biopsy specimens fulfilling
criteria for diagnosis of interstitial granulomatous dermatitis were
selected and correlated with the clinical and laboratory findings.
RESULTS: The study included 1 man and 16 women with multiple,
asymptomatic, round to oval, erythematous plaques, most often on
folds of the skin, in a bilateral and somewhat symmetric
distribution. Most of patients had rheumatoid polyarthralgias along
with various serologic abnormalities, often connected to collagen
vascular diseases. Histologic examination disclosed a distinctive
interstitial granulomatous dermatitis characterized by a diffuse
infiltration of the interstitium by histiocytes with piecemeal
fragmentation of collagen and formation of small granulomas around
degenerative areas in concert with variable numbers of
polymorphonuclear leukocytes sprinkled within the infiltrate. Churg-Strauss
granulomas in miniature and flame figures were occasionally observed
and indicated continued or increased activity of the associated
autoimmune disease(s). CONCLUSIONS: Interstitial granulomatous
dermatitis with plaques is a distinct entity with highly
reproducible clinical and histopathologic features; recognition of
these features identifies a patient who may have an underlying
systemic autoimmune disorder.
Interstitial
granulomatous dermatitis associated with pulmonary
coccidioidomycosis.J
Am Acad Dermatol. 2001 Dec;45(6):840-5.
BACKGROUND:
Coccidioides immitis is a soil-dwelling fungus found in arid regions
of the Western Hemisphere. Interstitial granulomatous dermatitis is
a histopathologic pattern that may be a reactive manifestation of
diverse systemic diseases. OBJECTIVE: Our purpose was to describe
clinical and histopathologic findings in 5 patients who presented
with interstitial granulomatous dermatitis associated with pulmonary
coccidioidomycosis. METHODS: Medical records and skin biopsy slides
from 5 patients were retrospectively reviewed. RESULTS: In each
patient, edematous papules, nodules, and plaques developed abruptly
during the onset of an acute febrile illness. Coccidioidomycosis was
confirmed by serology. Skin biopsy specimens revealed interstitial
granulomatous dermatitis with neutrophils, leukocytoclasis, and
eosinophils. Fungal stains (5/5 cases) and fungal cultures (2/2
cases) revealed no organisms within the skin biopsy specimens.
CONCLUSION: Interstitial granulomatous dermatitis may be a
presenting feature of pulmonary coccidioidomycosis and may possibly
represent a reactive manifestation of the infection.
Interstitial
granulomatous dermatitis with cutaneous cords and arthritis: a
disorder associated with autoantibodies.J
Am Acad Dermatol. 2001
Aug;45(2):286-91.
Interstitial
granulomatous dermatitis with arthritis is a new entity
characterized by linear or arciform subcutaneous cords. We describe
a patient presenting with typical cutaneous lesions extending from
the anterior and posterior part of the axillae to the flank. The
lesions had been present for 6 years with flares and remission.
Histopathologic examination revealed a bandlike infiltrate of
histiocytes in the reticular dermis with focal areas of palisading
around necrotic collagen bundles. A few atypical histiocytes were
also present. As previously described, it was associated with
serologic findings of an autoimmune disease, especially high titers
of anti-DNA antibodies. The possible inclusion of the interstitial
granulomatous dermatitis in the continuous spectrum of the palisaded
neutrophilic and granulomatous dermatitis of immune complex disease
is also discussed.
Interstitial
granulomatous dermatitis with plaques.Am
J Dermatopathol. 1999 Aug;21(4):320-3.
We report on
the clinical and histopathologic findings of four patients who had
asymptomatic, erythematous to violaceous plaques symmetrically
distributed on the upper aspect of the thighs, lateral chest, and in
two cases also on the abdomen and flexor surface of the elbows. All
of the patients were women; two of them had arthritis, which in one
case was associated with an autoimmune disorder, and another had
autoimmune thyroiditis. Histopathologically, all cases showed
similar changes consisting of an interstitial granulomatous
dermatitis involving mostly the lower reticular dermis. Histiocytes
were the predominant cellular component, arranged interstitially and
in small palisades around foci of degenerated collagen bundles in
concert with large numbers of neutrophils and eosinophils.
Interstitial granulomatous dermatitis can present different clinical
expressions, including linear cords, papules, and, as in our cases,
plaques. This peculiar histopathologic pattern falls into the
spectrum of cutaneous extravascular necrotizing granuloma, a
condition that is often associated with systemic autoimmune disease.
Interstitial
granulomatous dermatitis and paraneoplastic rheumatoid polyarthritis
disclosing cancer of the lung.
Ann Dermatol Venereol.
1998 Sep;125(9):585-8.
INTRODUCTION: Interstitial granulomatous dermatitis is a
histological entity usually associated with systemic auto-immune
conditions or malignant lymphoproliferation. Its spontaneous
regression after surgical treatment of a lung cancer suggests an
eventual paraneoplasic variant. OBSERVATION: A 62 year old male
patient, a smoker, was hospitalized for weakness, pruritus and
symmetrical arthritis of small and large joints. Numerous rheumatoid
nodules were located on the extensor aspects of the involved joints.
During hospitalization, he developed an inflammatory plaque located
on a thigh, which showed histologic features consistent with the
diagnosis of interstitial granulomatous dermatitis. He had elevated
E.S.R., blood eosiniphilia, and the search for antinuclear
antibodies and antineutrophilic leukocyte cytoplasm antibodies (ANCA),
of the p-ANCA type, was positive. A lung C.T. scan showed a cavitary
tumor. Surgical removal of this tumor evidenced a bronchial squamous
cell carcinoma. Four week after surgery, clinical signs and
eosinophilia disappeared. After 6 months, ANCA became undetectable.
DISCUSSION: Parallelism between the evolution of the cutaneous and
articular symptomatology and of the cancer are diagnosis of
paraneoplastic rheumatoid arthritis and paraneoplastic interstitial
granulomatous dermatitis. Paraneoplastic rheumatoid arthritis is
very unusual and this is the first reported case of simultaneously
occurring paraneoplastic interstitial granulomatous dermatitis.
Interstitial granulomatous dermatitis with arthritis.J
Am Acad Dermatol. 1996 Jun;34(6):957-61
BACKGROUND:
Interstitial granulomatous dermatitis with arthritis is an uncommon
systemic disorder involving the cutaneous and musculoskeletal
systems. The eruption may mimic other dermatoses including granuloma
annulare, erythema chronicum migrans, and the inflammatory stage of
morphea. Key histopathologic characteristics, along with clinical
correlation, allow accurate diagnosis. OBJECTIVE: We describe the
clinical, serologic, and histologic features in three patients with
interstitial granulomatous dermatitis with arthritis. METHODS: Skin
biopsy specimens were examined and correlated with the clinical and
laboratory findings. RESULTS: Erythematous, annular, indurated
plaques on the extremities were present in two women. An
erythematous, papular eruption on the head and neck was present in a
third patient. All patients had myalgia and migratory
polyarthralgias of the extremities along with various serologic
abnormalities. Histologic examination revealed a dense
lymphohistiocytic interstitial infiltrate involving primarily the
reticular dermis. Foci of necrobiotic collagen were present.
Vasculitis was absent. CONCLUSION: Interstitial granulomatous
dermatitis with arthritis is unique multisystem disease with
variable cutaneous expression. Abnormal serologic findings indicate
a possible connection to collagen vascular disease. |
Microscopic Image of
Interstitial Granulomatous Dermatitis.