Palisaded Neutrophilic and Granulomatous Dermatitis Manifested as a LE-nonspecific Skin Lesion.
- Author:
Tae Hoon KIM
1
;
Jeong Wan SEO
;
Seung Hwan CHOI
;
Ki Hoon SONG
;
Ki Ho KIM
Author Information
1. Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea. khkim@dau.ac.kr
- Publication Type:Case Report
- Keywords:
Palisaded neutrophilic and granulomatous dermatitis;
PNGD;
Systemic lupus erythematosus
- MeSH:
Antibodies, Antinuclear;
Arthritis;
Arthritis, Rheumatoid;
Autoimmune Diseases;
Biopsy;
Collagen;
Dermatitis*;
Dermis;
Elbow;
Female;
Fibrin;
Fibrosis;
Follow-Up Studies;
Glycoproteins;
Histiocytes;
Humans;
Hydroxychloroquine;
Inflammation;
Knee;
Lupus Coagulation Inhibitor;
Lupus Erythematosus, Systemic;
Mucins;
Neutrophils*;
Skin*;
Tacrolimus;
Vasculitis
- From:Korean Journal of Dermatology
2017;55(10):684-688
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a newly defined entity that includes various clinical entities. Histopathologically, this disease is characterized by a granulomatous inflammation with or without leukocytoclastic vasculitis. PNGD shows vasculitic lesions in the early stage, with palisaded granulomatous lesions and dermal fibrosis with minimal leukocytoclastic debris appearing in the late stage. It is frequently associated with rheumatoid arthritis, lupus erythematosus, and other autoimmune diseases. A 14-year old Korean girl presented with multiple erythematous nodules and plaques on both elbows and knees that were present for 2 years prior to the initial visit. Clinically, she had multiple arthritis with morning stiffness and decreased C3 levels, as well as positive results for antinuclear antibodies, the lupus anticoagulant test, and anti-beta 2 glycoprotein I (IgG). Skin biopsy findings from the skin lesion indicated that the foci of degenerated collagens were palisaded with histiocytes throughout the dermis and neutrophils with leukocytoclasia infiltrated with fibrin, with mucin at the center of the lesion. Based on the SLICC 2012 criteria, we diagnosed her condition as PNGD in systemic lupus erythematosus. She was treated with hydroxychloroquine and topical application of 0.1% tacrolimus ointment, which resulted in the remarkable flattening of the skin lesions after 6 months of follow-up. Herein, we report a case of PNGD that may have been an indicator of systemic lupus erythematosus.
