Necrobiosis lipoidica: a rare clinical and pathomorphological case

According to modern scientific researches, necrobiosis lipoidica (NL) is a disease characterized by focal disorganization and lipid collagen dystrophy. It is believed that the basis of skin changes in this dermatosis is diabetic microangiopathy that is accompanied by sclerosis and obliteration of blood vessels, which leads to necrobiosis with subsequent deposition of lipids in the dermis. This pathology is registered relatively rarely, in 1 % of patients with diabetes mellitus (DM) on average. The combination of NL with DM, according to the literature data, ranges from 25 to 70 %; more often (in 40–60 % of cases) DM is preceded by NL, and in 10–25 % of cases they occur simultaneously. In addition, in 10–50 % of cases NL is diagnosed in people without concomitant diabetes. The variability of clinical, epidemiological features and the relatively low prevalence of this pathology is often the cause for misdiagnosis or late diagnosis. The described clinical case is typical in terms of the epidemiological data: sex, age, presence of DM. At the same time, it is rare in terms of the clinical picture: it is not classically diabetic by localization (symmetrical areas of the legs are typical), by appearance of necrobiosis areas — granulomatous type of necrobiosis in the form of granuloma annulare, by histological structure — area of chronic perivascular lymphoplasmocytic inflammation with the involvement of single giant cells, which required additional clinical and anamnestic data for an objective report of the pathologist. Biopsy in this case was used as a differential diagnosis between granuloma annulare and necrobiotic necrogranuloma. In addition, this method of diagnosis has played an additional therapeutic role. This case may have demonstrated the activation of the cellular and humoral immune response in the area of chronic inflammation in response to a mechanical damage and the resolution of inflammation with complete tissue repair.

Granuloma anulare profondo

The author describes the case of a three-year-old girl presenting with a firm, painless retroauricular swelling finally diagnosed as deep granuloma annulare.

A Case Report of ChAdOx1 nCoV- 19 Corona Virus Recombinant Vaccine Related Granuloma Annulare

Background: Granuloma annulare (GA) is a benign, self-limiting inflammatory skin condition of unknown origin that may occur following multiple etiological triggers. GA incited secondary to vaccinations has been rarely reported in the medical literature. The COVID-19 pandemic has introduced extensive global immunization against the SARS-COV-2 virus, bringing a gamut of vaccine-related complications. We elucidate a case report of the spontaneous eventuality of GA following ChAdOx1 nCoV-19 Corona Virus Recombinant Vaccine. Case Report: A healthy 26-year male presented with a one-week history of asymptomatic single, flesh-pink patch with a raised margin over his left ventral forearm. On close examination, the margin of the lesion had multiple annularly arranged papules. Biopsy of lesion was done, and histopathology revealed numerous palisading granulomas in the dermis consistent with findings of localized GA. The patient was managed with once-daily external application high potent topical corticosteroids, which was used intermittently by the patient. However, the lesion showed spontaneous resolution in one month. Conclusion: Identifying ChAdOx1 nCoV- 19 Vaccine-related adverse events following its first dose is paramount, as evidence of the proportion of local or systemic severe cutaneous adverse skin reaction (SCAR) on subsequent dosing is a paucity. A more extensive systematic review corroborating SCARs and safety profile following immunization with ChAdOx1 nCoV-19 Vaccine prevails to be the need of the hour.