DERMATITIS GRANULOMATOSA INTERSTICIAL PDF

DermNet provides Google Translate, a free machine translation service. Note that this may not provide an exact translation in all languages. Granulomatous dermatitis describes several disorders characterised by their histological appearance. Interstitial granulomatous dermatitis is a rare skin disorder in which there is a particular pattern of granulomatous inflammation.

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Besides being an uncommon clinicopathological entity, interstitial granulomatous dermatitis, also described as interstitial granulomatous dermatitis with arthritis IGDA , has shown a wide spectrum of clinical manifestations, such as linear and erythematous lesions, papules, plaques and nodules.

Histological features include dense dermal histiocytic infiltrate, usually in a palisade configuration, and scattered neutrophils and eosinophils. We describe a middle aged woman with rheumatoid arthritis of difficult management and cutaneous lesions compatible with IGDA.

Interstitial granulomatous dermatitis was initially described by Ackerman et al in Its clinical manifestations are variable. Classically it presents itself as linear subcutaneous cords, known as rope sign. At the histopathological examination, infiltration of reticular dermis was observed with predominance of interstitial and palisaded histiocytes and some areas of collagenous degeneration, associated with a lower number of neutrophils and eosinophils.

The main associated disease is RA, which may be diagnosed before, concomitantly or after the onset of lesions. Right thigh. Papules, annular plaques and erythematous-purplish infiltrated nodules on medial surface of right thigh.

Left thigh. Papules, annular plaques and erythematous-purplish infiltrated nodules on medial surface of left thigh. Pathological history: RA, diagnosed 10 years ago with symmetrical deforming polyarthritis of the small-joints of hands and being monitored by the Rheumatology Service of HSPE-SP; systemic arterial hypertension and obesity. Laboratory tests: rheumatoid factor present at high titers on the occasion of rheumatoid arthritis diagnosis, anti-cyclic citrullinated peptide antibodies present, increased inflammatory markers, without alterations in other tests.

Elbow lesion. Detail of interstitial granulomatous infiltrate amid thickened collagen. HEAO x. Normal epidermis for this site, without basal cell vacuolar degeneration. Dermis with moderate infiltrate predominantly histiocytic amid deteriorated and thickened collagen. Although the original manifestation had been described as subcutaneous linear nodules, also known as rope sign 1 , later reports showed a clinical spectrum quite heterogeneous which vary from hyperpigmented, erythematous papules, subcutaneous plaques, annular lesions to firm red-purplish nodules as observed in our patient.

The histopathological examination defines the diagnosis characterized as dense and diffuse interstitial infiltrate in the reticular dermis, composed of histiocytes in a palisade arrangement, sometimes with necrobiosis of collagen and involved by some neutrophils and eosinophils.

It is histopathologically characterized for affecting all the dermis, differently from IGDA, which is located in the middle and deep dermis and demonstrates an infiltrate rich in neutrophils, with vascular alterations and leukocytoclasia. Its physiopathology is uncertain, however the association with autoimmune diseases and vasculitides suggests a mechanism mediated by immunocomplexes. Pharmacological etiology has also been reported and the most frequently drugs involved are the antihypertensives, such as the angiotensin-converting-enzyme inhibitors, calcium channel blockers, beta blockers, diuretics, in addition to hypolipidemic agents, anticonvulsants, antihistamines and TNF-alpha blockers.

Differential diagnosis includes other entities related to rheumatoid arthritis, such as rheumatoid nodules, rheumatoid vasculitis, palisaded neutrophilic and granulomatous dermatitis, in addition to rheumatoid neutrophilic dermatosis, which, unlike the latter, presents neutrophilic dermal infiltrate and leukocytoclasia without vasculitis under histopathology.

The therapy of choice is still not well-defined. Considering IGDA as a rare entity, the knowledge of its manifestations and its essential association with rheumatoid arthritis contributes to clinical suspicion, since its wide spectrum presentation makes its diagnosis difficult. Dermatologists should be alert to this diagnostic possibility, for they are already in a privileged position when monitoring these patients.

Thigh lesion. Detail of infiltrate with histiocytes, lymphocytes, eosinophils and neutrophils amid thickened collagen. Dense inflammatory infiltrate in interstitial thickened collagen. Financial Support: None. Conflict of Interest: None. Interstitial granulomatous dermatitis: rare cutaneous manifestation of rheumatoid arthritis. An Bras Dermatol. National Center for Biotechnology Information , U. Journal List An Bras Dermatol v.

Author information Article notes Copyright and License information Disclaimer. E-mail: rb. Received Nov 12; Accepted Nov This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Besides being an uncommon clinicopathological entity, interstitial granulomatous dermatitis, also described as interstitial granulomatous dermatitis with arthritis IGDA , has shown a wide spectrum of clinical manifestations, such as linear and erythematous lesions, papules, plaques and nodules. Keywords: Rheumatoid arthritis, Dermatitis, Granuloma. Open in a separate window. Footnotes Financial Support: None.

Reference 1. Ackerman A. Clues to Diagnosis in Dermatopathology. Dermatol Online J. Interstitial granulomatous dermatitis with arthritis. Sayah A, English JC. Rheumatoid arthritis: A review of the cutaneous manifestations. J Am Acad Dermatol. Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis.

Relapsing polychondritis, interstitial granulomatous dermatitis and antiphospholipid syndrome: an unusual clinical association. Acta Reumatol Port. Rheumatoid Neutrophilic Dermatitis. Arch Dermatol. Romiti R, Sakai N. Dermatite intersticial granulomatosa com artrite. Variante do granuloma anular? Support Center Support Center. External link. Please review our privacy policy.

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Mailing address. A year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare.

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Granulomatous dermatitis

Besides being an uncommon clinicopathological entity, interstitial granulomatous dermatitis, also described as interstitial granulomatous dermatitis with arthritis IGDA , has shown a wide spectrum of clinical manifestations, such as linear and erythematous lesions, papules, plaques and nodules. Histological features include dense dermal histiocytic infiltrate, usually in a palisade configuration, and scattered neutrophils and eosinophils. We describe a middle aged woman with rheumatoid arthritis of difficult management and cutaneous lesions compatible with IGDA. Interstitial granulomatous dermatitis was initially described by Ackerman et al in Its clinical manifestations are variable. Classically it presents itself as linear subcutaneous cords, known as rope sign. At the histopathological examination, infiltration of reticular dermis was observed with predominance of interstitial and palisaded histiocytes and some areas of collagenous degeneration, associated with a lower number of neutrophils and eosinophils.

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