scholarly journals Interstitial granulomatous dermatitis: a rare case report of dermatological manifestation of rheumatoid arthritis

2020 ◽  
Vol 8 (7) ◽  
pp. 2688
Author(s):  
Jagadeesh Chandrasekaran ◽  
Neetu Mariam Alex
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Fungal Infections ◽  
Histopathological Examination ◽  
Specific Treatment ◽  
Granulomatous Inflammation ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Solid Organ ◽  
Granulomatous Dermatitis

Interstitial granulomatous dermatitis (IGD), a rare dermatological disorder was first described by Ackerman et al, in the year 1993. It is characterized by a heterogeneous clinical spectrum and a specific histopathological pattern. It has been described in association with a number of auto-immune disorders, drugs, fungal infections, and malignancies. It may manifest as papules, patches, plaques, nodules, annular lesions, or less frequently, as described classically, as indurated linear subcutaneous cords. This case is being reported as interstitial granulomatous dermatitis is rare dermatological manifestation of rheumatoid arthritis and presentation as large ulcerated skin lesions is further extremely rare. In this case report we describe a 67-year-old gentleman with Seropositive Rheumatoid arthritis. He presented to our hospital with complaints of multiple well defined skin lesions with pus discharge over lower limbs, trunk and upper limbs. Biopsies from left upper limb and abdomen showed focal necrobiosis with surrounding granulomatous inflammation with rare perivascular granulomas. He was subsequently diagnosed to have interstitial granulomatous dermatitis based on histopathological examination. Interstitial granulomatous dermatitis has been described to be associated with a number of autoimmune conditions and drugs. It is very important for clinicians to have knowledge about this rare skin condition as it may be heralding presentation of a serious underlying condition like lymphoproliferative disorders or solid organ malignancies. There is no specific treatment and causative disease has to be diagnosed and targeted.

scholarly journals Granulomatous Skin Lesions in Moray Eels Caused by a Novel Mycobacterium Species Related toMycobacterium triplex

2001 ◽  
Vol 69 (7) ◽  
pp. 4639-4646 ◽  
Author(s):  
Lawrence H. Herbst ◽  
Sylvia F. Costa ◽  
Louis M. Weiss ◽  
Linda K. Johnson ◽  
John Bartell ◽  
...  
Keyword(s):  
Room Temperature ◽  
Histopathological Examination ◽  
Granulomatous Inflammation ◽  
Skin Lesions ◽  
Rrna Gene ◽  
Mycobacterium Species ◽  
Skin Nodules ◽  
Granulomatous Dermatitis ◽  
Axial Musculature ◽  
The 16S Rrna Gene

ABSTRACT An outbreak of granulomatous dermatitis was investigated in a captive population of moray eels. The affected eels had florid skin nodules concentrated around the head and trunk. Histopathological examination revealed extensive granulomatous inflammation within the dermis and subcutaneous fascial plane between the fat and axial musculature. Acid-fast rods were detected within the smallest lesions, which were presumably the ones that had developed earliest. Eventually, after several months of incubation at room temperature, a very slowly growing acid-fast organism was isolated. Sequencing of the 16S rRNA gene identified it as a Mycobacterium species closely related (0.59% divergence) to M. triplex, an SAV mycobacterium. Intradermal inoculation of healthy green moray eels with this organism reliably reproduced the lesion. Experimentally induced granulomatous dermatitis appeared within 2 weeks of inoculation and slowly but progressively expanded during the 2 months of the experiment. Live organisms were recovered from these lesions at all time points, fulfilling Koch's postulates for this bacterium. In a retrospective study of tissues collected between 1993 and 1999 from five spontaneous disease cases, acid-fast rods were consistently found within lesions, and a nested PCR for the rRNA gene also demonstrated the presence of mycobacteria within affected tissues.

scholarly journals A Histopathological Study of Granulomatous Inflammation

2012 ◽  
Vol 02 (01) ◽  
pp. 15-19 ◽  
Author(s):  
Harish S. Permi ◽  
Jayaprakash Shetty K. ◽  
Shetty K. Padma ◽  
Teerthanath S. ◽  
Michelle Mathias ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Histopathological Examination ◽  
Subcutaneous Tissue ◽  
Specific Treatment ◽  
Granulomatous Inflammation ◽  
Histopathological Study ◽  
Serological Tests ◽  
Medical Academy ◽  
Granulomatous Lesions ◽  
Exact Etiology

AbstractGranulomatous inflammation is a distinctive pattern of chronic inflammation that is encountered in a limited number of infectious and non-infectious conditions. Recognisation of granulomatous pattern and finding the etiology in a biopsy specimen is very important for specific treatment and outcome of the disease. We aimed at finding the etiology of all granulomatous lesions on tissue biopsy sent for histopathogical examination. A study was done at K S Hegde Medical Academy of Nitte University, Mangalore from January 2009 to December 2010. All the cases which were diagnosed as granulomas on Hematoxylin and Eosin stained sections were selected. Special stains like Ziehl-Neelsen stain, Gomori's Methenamine silver, PAS, Fite Faraco were done whenever required. We encountered 275 granulomatous lesions in our study. The most common sites were skin and subcutaneous tissue, lymph nodes, bones and joints. The commonest cause of granulomas was tuberculosis, followed by leprosy, foreign body granulomas, fungal infections, rhinoscleroma, parasites, tumor granulomas and actinomycosis. The morphological features and special staining helped us to find the specific etiology of granulomas in 253 cases whereas it could not be determined in 22 cases even after special stains. Thus we conclude that histopathological examination of granulomatous lesions helped us to find the exact etiology of granulomas in 92 % of cases. The correlation of histopathology with polymerase chain reaction (PCR) serological tests and culture correlation would have helped to find the specific etiology in the remainder of cases.

scholarly journals Palisaded neutrophilic and granulomatous dermatitis following a long-standing monoclonal gammopathy: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2097956
Author(s):  
Dorsa Zabihi-pour ◽  
Bahar Bahrani ◽  
Dalal Assaad ◽  
Jensen Yeung
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Connective Tissue ◽  
Monoclonal Gammopathy ◽  
Inflammatory Dermatosis ◽  
Case Summary ◽  
Underlying Causes ◽  
Granulomatous Dermatitis ◽  
Skin Biopsies ◽  
Underlying Diseases

Background: Palisaded neutrophilic granulomatous dermatitis is a rare inflammatory dermatosis with possible underlying systemic conditions including rheumatoid arthritis, autoimmune connective tissue disease, and malignancies. Case Summary: We report a case of an 84-year-old man presenting with a 3-week eruption of asymptomatic annular plaques on his neck, which progressed to involve his back and legs. Skin biopsies confirmed a diagnosis of palisaded neutrophilic granulomatous dermatitis, and he was treated with prednisone. Full workup related to potential underlying causes of palisaded neutrophilic granulomatous dermatitis was completed. Conclusion: Palisaded neutrophilic granulomatous dermatitis may precede the onset of underlying systemic conditions or occur concomitantly. Following the diagnosis, clinicians should perform a comprehensive focused history, physical examination, and laboratory investigation related to the associated underlying diseases.

scholarly journals Mycotic skin lesions in an adult reindeer caused by Debaryomyces bansenii. A case report

Rangifer ◽  
1994 ◽  
Vol 14 (3) ◽  
pp. 129
Author(s):  
Claes Rehbinder ◽  
Roland Mattsson
Keyword(s):  
Case Report ◽  
Fungal Infections ◽  
Skin Lesions ◽  
Supplementary Feeding ◽  
The Other ◽  
Other Hand ◽  
Dry Conditions

This report apparently is the first to describe candidosis in reindeer. It is imperative that reindeer kept in corrals during winter and spring for supplementary feeding, are provided clean, dry conditions and that strict hygenic measures are followed. If reindeer on the other hand are kept in dirty, wet and muddy corrals, among other things, skin lesions due to fungal infections may possibly appear rather frequently.

scholarly journals Monoarticular synovitis of knee: dealing with the dilemma

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 48
Author(s):  
Tarun Goyal ◽  
Souvik Paul ◽  
Arghya Kundu Choudhury ◽  
Tushar Kalonia
Keyword(s):  
Rheumatoid Arthritis ◽  
Histopathological Examination ◽  
Specific Treatment ◽  
Pigmented Villonodular Synovitis ◽  
Functional Improvement ◽  
Villonodular Synovitis ◽  
Duration Of Symptoms ◽  
Large Joint ◽  
Chronic Synovitis ◽  
Pigmented Villonodular

Introduction: Chronic synovitis involving a single large joint remains a diagnostic dilemma. We present 61 cases of chronic synovitis of the knee, followed prospectively for 2 years. The study focuses on the diagnosis, management, and histopathological correlation. Methods: We prospectively studied 61 patients with chronic mono-articular synovitis of the knee joint, between July 2016 and September 2017. All patients underwent plain radiographs, magnetic resonance imaging, and arthroscopic examination with synovial biopsy. Further treatment was based on findings of histopathological examination. Results: The average duration of symptoms was 7.72 ± 4.34 months. The mean age at presentation was 29.93 ± 15.56 years. Results of histopathological examination showed chronic nonspecific inflammation in 28 patients (46%), features suggesting tubercular infection in 19 patients (31%), pigmented villonodular synovitis in seven patients (11.5%), rheumatoid arthritis in three (5%) patients, acute inflammation in three (5%) patients and findings suggestive of synovial chondromatosis in one (1.5%) patient. Treatment was based on histopathological results. Intra-articular injections of methylprednisolone (80 mg depot preparation) were given to all patients with nonspecific synovitis and rheumatoid arthritis. Anti-tubercular treatment was started for patients with tubercular synovitis. Complete arthroscopic/open synovectomy followed by radiotherapy was carried out for patients with pigmented villonodular synovitis. Non-steroidal anti-inflammatory drugs are used for patients with acute on chronic inflammation. All patients had symptomatic relief and functional improvement in further follow-up. Discussion: Histopathological reporting remains the mainstay for diagnosis. The various differentials should always be kept in mind when approaching patients with chronic mono-articular synovitis. Specific treatment can be started once the diagnosis is confirmed.

Hemangiopericytoma – a case report of a rare tumour of the parapharyngeal space

2017 ◽  
Vol 6 (2) ◽  
pp. 56-63
Author(s):  
Klaudia Cybulska ◽  
Małgorzata Jarosz ◽  
Anna Rzepakowska ◽  
Kazimierz Niemczyk
Keyword(s):  
Case Report ◽  
Parapharyngeal Space ◽  
Histopathological Examination ◽  
Therapeutic Process ◽  
Surgical Excision ◽  
Lower Limbs ◽  
Diagnostic Process ◽  
Tumour Resection ◽  
Rare Tumour ◽  
Long Term Follow Up

Introduction: Hemangiopericytoma is a mesenchymal tumour originating from pericytes surrounding the capillary vessels. The etiology of this tumour is still unknown. It may be located in any part of the human body. The most common sites are pelvis and lower limbs and less often it occurs in the head and neck. The characteristic signs of hemangiopericytoma are slow growth regardless of the malignancy level and high vascularity. Surgical excision of the tumour with additional radiotherapy is the treatment of choice. Case report: A symptom presentation and diagnostic-therapeutic process in a 71-year-old woman admitted to the Department of Otolaryngology of the Medical University of Warsaw due to increasing bilateral nasal obstruction and dysphagia is herein described. Diagnostic imaging showed highly vascularized tumour in the parapharyngeal space also obstructing the left side of the nasopharynx. After evaluation, tumour resection from the external approach was planned and performed, followed by an uncomplicated postoperative course. Histopathological examination revealed hemangiopericytoma. The patient was qualified for adjuvant radiotherapy. She stays under observation with no signs of recurrence since surgery. Conclusions: Hemangiopericytoma is a rare tumour with a wide variety of clinical presentations and a relapse-free survival that is difficult to predict. Long-lasting asymptomatic tumour growth results in late diagnosis. Imaging and primarily, histopathological examination are fundamental for the diagnostic process. The best outcome is observed after radical surgical treatment. In order to reduce the risk of recurrence, additional radiotherapy is advised. Local recurrence may appear years after finished treatment, therefore long-term follow-up is essential.

scholarly journals Grover’s disease in a patient with atopic dermatitis - a case report

2021 ◽  
Vol 74 (1-2) ◽  
pp. 33-37
Author(s):  
Sanja Jakovljevic ◽  
Ljuba Vujanovic ◽  
Dejan Ogorelica ◽  
Aleksandra Fejsa-Levakov ◽  
Jasmina Sekulic
Keyword(s):  
Case Report ◽  
Immunoglobulin E ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Elevated Serum ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Complete Regression ◽  
Laboratory Findings ◽  
Topical Corticosteroids

Introduction. Grover?s disease is characterized by pruriginous polymorphic rash with a variable course and duration. Although the etiology is still unknown, the disease is often associated with other dermatoses, malignant diseases, use of certain medications, as well as immunosuppression. Case Report. We report a case of a 70-year-old male patient who was referred for examination to the Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, due to a rash that lasted for nine months. The first lesions on the skin appeared around the nipples as exudative eczematous plaques. A few months later, identical lesions appeared on the lower legs. During treatment with systemic antihistamines and topical corticosteroids, there were episodes of transient improvements and re-exacerbations. In the meantime, erythematous brownish, round and oval papules appeared on the abdomen and the back, accompanied by intense itch. Laboratory findings revealed eosinophilia and elevated serum immunoglobulin E levels. A skin biopsy of the back lesion was performed and the histopathological examination confirmed the diagnosis of Grover?s disease. After the systemic treatment using corticosteroids and antihistamines, with gradual dose reduction and application of topical corticosteroids and emollients, complete regression of the skin lesions was achieved. Conclusion. Since the clinical manifestations of the disease may be nonspecific and discrete, dermatopathological analysis is of crucial importance in making the correct diagnosis. In patients with atopy, the treatment with systemic corticosteroids, antihistamines and topical agents may lead to regression of skin lesions with a significant improvement in the quality of life.

scholarly journals Juvenile sterile granulomatous dermatitis (puppy strangle) in Pekingese and German shepherd puppies

2015 ◽  
Vol 5 (1) ◽  
Author(s):  
Mohammad Abbaszadeh Hasiri ◽  
Efat Baghaei Moghaddam
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Bacterial Culture ◽  
Skin Lesions ◽  
Response To Therapy ◽  
Skin Scraping ◽  
German Shepherd ◽  
Present Case Report ◽  
The Face ◽  
Granulomatous Dermatitis

Juvenile sterile granulomatous dermatitis is an uncommon granulomatous and pustular disorder of the face, pinnae, and submandibular lymph nodes of puppies. A 10-week-old male Pekingese and a 8-week-old female German shepherd presented with submandibular lymphadenomegaly, skin lesions on muzzle and periocular area (Papules, crusts and pustules). The case did not respond to antibiotic therapy. Results of a hemogram, biochemical panel, and urinalysis were normal. Due to skin scraping, cytology examination (impression smear), fungal and bacterial culture and response to therapy puppy strangle (juvenile cellulitis) was diagnosed. The puppies made a full recovery on glucocorticoid therapy. The present case report describes the first report of juvenile sterile granulomatous dermatitis in Iran.

scholarly journals P38 A rare case of rheumatoid arthritis with perforating collagenosis

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Subhasish Deb ◽  
Srinivasan Srirangan
Keyword(s):  
Rheumatoid Arthritis ◽  
Skin Biopsy ◽  
Rare Case ◽  
Skin Lesions ◽  
The Body ◽  
Topical Steroids ◽  
Rheumatoid Vasculitis ◽  
Cutaneous Manifestations ◽  
Granulomatous Dermatitis ◽  
Disease Modifying

Abstract Background Rheumatoid arthritis has multiple cutaneous manifestations with rheumatoid nodule being the commonest one. A maculopapular rash in setting of rheumatoid arthritis has a varied list of differentials including rheumatoid vasculitis, pyoderma gangrenosum, rheumatoid neutrophilic dermatosis, interstitial granulomatous dermatitis and palisaded neutrophilic granulomatous dermatitis. We present a rare case of patient with rheumatoid arthritis with perforating collagenosis. Methods A case report is presented in the results section. Results A 64 year old lady known to have seropositive rheumatoid arthritis for the past 6 years with poor compliance to treatment presented with maculopapular lesions on both her legs and abdomen. The lesions were itchy in nature and later became ulcerative. The lesions spread to various parts of the body over the next 4 weeks and patient was seen by a dermatologist who initially prescribed topical therapy and the patient came off her disease modifying anti rheumatic agents. She underwent a skin biopsy as initial investigations were otherwise unremarkable. Skin biopsy revealed a diagnosis of perforating collagenosis. She was given topical steroids and counselled regarding the need to take her disease modifying anti rheumatic drugs regularly. There was 95% resolution of skin lesions within 6 months. Conclusion Perforating collagenosis is a skin disorder characterised by transepithelial expulsion of dermal tissue which presents as a papulonodular rash with central keratin plugs. It is usually associated with diabetes mellitus and chronic kidney disease but rarely been reported in association with rheumatoid arthritis. Literature review revealed that there have been only 2 cases reported previously. The first case has been described in 2010 in a man from Singapore on treatment for RA for 2 years. Second case has been described by Ikeda et al in 2019 in a case of rheumatoid vasculitis. Clinically it presents as umbilicated, hyperkeratotic papules with a central white keratotic crust. Koebnerization may be seen and itching of surrounding regions may lead to papules to coalesce and form plaques. A biopsy will reveal features similar to those seen in the primary disease where perforating collagenosis shows cup shaped invagination of the epidermis filled with a plug consisting of keratin and cellular debris. There have been no trials and treatment is based on case reports. We believe that better compliance to her disease modifying anti rheumatic agent therapy, leading to improved treatment of the systemic cause had a significant role in resolving her skin lesions. Disclosures S. Deb None. S. Srirangan None.

TRICHILEMMAL CYST OF THE THIRD FINGERTIP: A CASE REPORT

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 131-133 ◽  
Author(s):  
Cenk Melikoglu ◽  
Fikret Eren ◽  
Barış Keklik ◽  
Cem Aslan ◽  
Mustafa Sutcu ◽  
...  
Keyword(s):  
Case Report ◽  
Histopathological Examination ◽  
Surgical Excision ◽  
Skin Lesions ◽  
Hair Follicles ◽  
Nodular Lesion ◽  
Case Presentation ◽  
The Third ◽  
Trichilemmal Cyst ◽  
Common Skin

Introduction: Trichilemmal cysts (TCs) are common skin lesions that occur in hairy areas. A TC involving a fingertip has not been previously described in the literature. We herein report a case of a TC occupying a fingertip region. Case presentation: A 43-year-old woman presented with a 1.5 × 1.5 cm nodular lesion on the third fingertip. The lesion was completely excised, and histopathological examination revealed a TC. Conclusion: TCs may involve atypical locations, such as fingertips, where there are no hair follicles. After surgical excision, a careful histopathological examination should be performed to differentiate TCs from proliferating pilar tumors.

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