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Vempuluru VS, Singla K, Milman T, Eagle RC, Lally SE, Shields CL. Bilateral Conjunctival Actinic Granuloma With Necrobiotic Vasculitic Pattern: A Diagnosis of Exclusion. Ophthalmic Plast Reconstr Surg 2023; 39:e173-e176. [PMID: 37279029 DOI: 10.1097/iop.0000000000002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 53-year-old Caucasian male presented with an inflamed-appearing limbal nodule in his OD, clinically compatible with nodular episcleritis, that was unresponsive to topical corticosteroid therapy. Excisional biopsy of the lesion was performed and histopathological examination revealed foci of necrotizing vasculitis and granulomatous inflammation in a background of intense actinic elastosis. Infectious stains for organisms were negative. A comprehensive systemic evaluation for vasculitides was negative. Three years later, the patient returned with a clinically and histopathologically identical lesion in his OS. Systemic evaluation was noncontributory again, and a diagnosis of bilateral conjunctival actinic granuloma with necrobiotic vasculitic pattern was made.
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Affiliation(s)
| | - Konica Singla
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University
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2
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Mulhearn B, Ellis J, Skeoch S, Pauling J, Tansley S. Incidence of giant cell arteritis is associated with COVID-19 prevalence: A population-level retrospective study. Heliyon 2023; 9:e17899. [PMID: 37483752 PMCID: PMC10359857 DOI: 10.1016/j.heliyon.2023.e17899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Following the first wave of the COVID-19 pandemic, it was observed that giant cell arteritis (GCA) diagnoses increased at the Royal National Hospital for Rheumatic Diseases (RNHRD) in Bath, UK. This finding may support the viral aetiology hypothesis of GCA. Better understanding of the causes of GCA may help improve diagnostic and treatment strategies leading to better outcomes for patients. Objectives The study aims to estimate the local incidence of GCA during the early COVID-19 pandemic (2020-2021) and compare it to pre-pandemic (2015-2019) data. This study will also evaluate the temporal relationship between COVID-19 infections and GCA diagnoses. Methods Annual incidence rates of GCA were calculated between 2015 and 2021. Local COVID-19 prevalence was estimated by measuring the number of hospital beds taken up by COVID-19 positive patients. Poisson statistics were used to compare the annual mean incidence of GCA between 2019 and 2020, and Granger causality tested the temporal relationship between COVID-19 prevalence and GCA incidence. Results There were 60 (95% confidence interval [CI] 46-77) GCA diagnoses made in 2020 compared to 28 (CI 19-41) in 2019 (P = 0.016). Peaks in the number of COVID-19 inpatients correlated with peaks in GCA diagnoses. Granger causality testing found a statistically significant association between these peaks with a lag period of 40-45 days. Conclusion The incidence of GCA in Bath was significantly increased in 2020 and 2021 compared to 2015-2019. The lag period between peaks was 40-45 days, suggesting that the COVID-19 virus may be a precipitating factor for GCA. More work is currently underway to interrogate the causal relationship between these two diseases.
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Affiliation(s)
- Ben Mulhearn
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Jessica Ellis
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Sarah Skeoch
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - John Pauling
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
- North Bristol Hospital NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Sarah Tansley
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
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3
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Magan T, Rapuano CJ, Ayres BD, Skeens HM, Goyal V, Heersink S, Meghpara BB, Syed ZA, Eagle RC, Milman T. Actinic Granuloma of the Conjunctiva: Case Series and Review of the Literature. Am J Ophthalmol 2021; 229:120-126. [PMID: 33895150 DOI: 10.1016/j.ajo.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To characterize the clinical and histopathologic features of actinic granuloma of the conjunctiva. DESIGN Retrospective observational case series METHODS: Institutional pathology records between 2014 and 2020 were searched for all cases of conjunctival actinic granuloma. Information collected included age, sex, ocular and medical history, clinical findings, laboratory workup, treatment, follow-up, pathologic diagnosis, and histopathologic inflammation pattern. RESULTS Eight eyes of 8 patients, 5 men and 3 women, with a median age of 43 years (mean 49, range 24-83) were identified. Clinical diagnosis was pterygium (n = 4, 50%), inflamed pterygium (n = 1, 13%), pterygium vs conjunctival squamous cell carcinoma (n = 1, 13%), episcleritis vs inflamed pinguecula (n = 1, 13%), and scleritis vs keratoacanthoma (n = 1, 13%). Of 5 lesions with follow-up information, none recurred following excision with a median follow-up of 9 weeks (mean 19 weeks, range 1-61 weeks). Allergy/atopy was documented in 4 of 7 (57%) patients with available medical information. There were no other systemic associations. Histopathologically, actinic granuloma was associated with pterygium (n = 6, 75%) and pinguecula (n = 2, 25%). All lesions were composed predominantly of histiocytes and a variable number of foreign body-type giant cells associated with a focus of severe actinic elastosis. The inflammatory pattern was giant cell (n = 4, 50%), sarcoidal (n = 2, 25%), histiocytic (n = 1, 13%), and combined histiocytic and sarcoidal (n = 1, 13%). CONCLUSION Conjunctival actinic granuloma has diverse clinical and histopathologic manifestations, which need to be distinguished from other autoimmune, neoplastic, and infectious etiologies. This lesion frequently occurs in pre-existing pterygium and pinguecula and may be associated with allergy and atopy.
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Affiliation(s)
- Tejal Magan
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brandon D Ayres
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Heather M Skeens
- West Virginia Cornea and Cataract Center of Excellence, South Charleston, West Virginia
| | - Vipin Goyal
- Nevyas Eye Associates, Philadelphia, Pennsylvania
| | | | - Beeran B Meghpara
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zeba A Syed
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
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4
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Chen WT, Huang CH, Chi CC. Actinic granuloma successfully treated with low-dose doxycycline. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Abstract
Annular elastolytic giant cell granuloma (AEGCG) is a rare, often self-limiting chronic inflammatory disorder mostly occurring in the sun-exposed areas such as the dorsum of hands, extensor surfaces of arms, face, anterior neck, and upper chest. The pathognomonic histological findings include the presence of numerous granulomas associated with loss of elastic fibers that appear to be ingested by multi-nucleated giant cells. Here, we present a case of a 56-year-old woman with multiple, anatomically variable erythematous lesions- annular and papular, mainly in the upper body. The clinical presentation and histopathologic findings support our diagnosis.
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Affiliation(s)
- Anuja Mahesh Mistry
- Internal Medicine, Smt Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Rutul Patel
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Mahesh Mistry
- Dermatology and Venereology, Saham Hospital, Saham, OMN
| | - Varna Menon
- Pathology and Laboratory Medicine, Sohar Hospital, Sohar, OMN
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6
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Hysa E, Sobrero A, Camellino D, Rumi F, Carrara G, Cutolo M, Scirè CA, Cimmino MA. A seasonal pattern in the onset of polymyalgia rheumatica and giant cell arteritis? A systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50:1131-1139. [PMID: 32920326 DOI: 10.1016/j.semarthrit.2020.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Studies on the seasonality of onset of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) have shown conflicting results. The aim of this systematic literature review and meta-analysis is to determine from aggregated data whether there is a seasonal distribution for these diseases. METHODS A literature search was performed using Pubmed Central and Embase scientific databases. The incidences per 6-month periods, season or month of onset, that were reported in the studies were summarised in tables considering the two diseases as separate conditions or together. The Incidence Rate Ratio (IRR) for the cold period versus the warm period was pooled across studies by random effects meta-analysis weighed by inverse variance. Funnel plots and Egger test were used to explore possible publication biases. A sensitivity analysis was performed to weigh articles with a disproportionate number of patients compared to the rest. RESULTS In the scientific literature 22 suitable papers were found: 6 on PMR with 803 patients, 11 on GCA with 2,807 patients, and 5 studies considering both diseases with 19,613 patients. There was considerable heterogeneity amongst studies regarding their quality, the classification criteria used, and the definition of onset of symptoms. No seasonal aggregation was found for GCA and PMR. The pooled IRR estimate of the meta-analysis (1.13[0.89,1.36]) showed a non-significant, higher frequency of diseases onset in the warm season. CONCLUSIONS Our meta-analysis did not confirm a seasonal onset for PMR and GCA.
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Affiliation(s)
- E Hysa
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
| | - A Sobrero
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - D Camellino
- Division of Rheumatology, "La Colletta" Hospital, Azienda Sanitaria Locale 3, Arenzano, Italy
| | - F Rumi
- Epidemiology Research Unit, SIR, Società Italiana di Reumatologia, Milano, Italy.
| | - G Carrara
- Epidemiology Research Unit, SIR, Società Italiana di Reumatologia, Milano, Italy.
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
| | - C A Scirè
- Epidemiology Research Unit, SIR, Società Italiana di Reumatologia, Milano, Italy; Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - M A Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
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7
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Pflederer RT, Ahmed S, Tonkovic-Capin V, Vaughan L. Annular polycyclic plaques on the chest and upper back. JAAD Case Rep 2018; 4:405-407. [PMID: 29984264 PMCID: PMC6031479 DOI: 10.1016/j.jdcr.2017.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachel T Pflederer
- Division of Dermatology, Veterans Affairs Medical Center, Kansas City, Kansas.,Division of Dermatology, Kansas University Medical Center, Kansas City, Kansas
| | - Saquib Ahmed
- Division of Dermatology, Veterans Affairs Medical Center, Kansas City, Kansas.,Division of Dermatology, Kansas University Medical Center, Kansas City, Kansas
| | - Viseslav Tonkovic-Capin
- Division of Dermatology, Veterans Affairs Medical Center, Kansas City, Kansas.,Department of Pathology and Laboratory Medicine, Veterans Affairs Medical Center, Kansas City, Kansas
| | - Lynn Vaughan
- Division of Dermatology, Veterans Affairs Medical Center, Kansas City, Kansas
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8
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Rozas-Muñoz E, Mir-Bonafé J, Serra-Baldrich E. Bilateral Annular Plaques on the Hands and Forearms. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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9
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Rozas-Muñoz E, Mir-Bonafé JF, Serra-Baldrich E. Bilateral Annular Plaques on the Hands and Forearms. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:263-264. [PMID: 28963029 DOI: 10.1016/j.ad.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 04/06/2017] [Accepted: 04/09/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- E Rozas-Muñoz
- Servicio de Dermatología, Hospital de la Sant Creu i Sant Pau, Barcelona, España.
| | - J F Mir-Bonafé
- Servicio de Dermatología, Hospital de la Sant Creu i Sant Pau, Barcelona, España
| | - E Serra-Baldrich
- Servicio de Dermatología, Hospital de la Sant Creu i Sant Pau, Barcelona, España
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10
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Michaelis TC, Woodcock JL, Basic KK. Actinic granuloma presenting as tender, linear plaques on the lateral fingers in a patient with newly diagnosed esophageal cancer. JAAD Case Rep 2017; 3:55-57. [PMID: 28229119 PMCID: PMC5311424 DOI: 10.1016/j.jdcr.2016.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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11
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Pham AK, Dinulos JG, Quinn TR. Annular elastolytic giant cell granuloma after a cardiac pacemaker implantation. JAAD Case Rep 2016; 2:357-9. [PMID: 27622209 PMCID: PMC5007655 DOI: 10.1016/j.jdcr.2016.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Anh Khoa Pham
- Section of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - James G Dinulos
- University of Connecticut, Farmington, Connecticut; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Seacoast Dermatology, Portsmouth, New Hampshire
| | - Timothy R Quinn
- Dermpath Diagnostics New England, Marlborough, Massachusetts
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12
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Tronnier M, Mitteldorf C. Histologic features of granulomatous skin diseases. Part 1: Non-infectious granulomatous disorders. J Dtsch Dermatol Ges 2015; 13:211-6. [PMID: 25721629 DOI: 10.1111/ddg.12610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Granulomatous disorders affecting the skin belong to a heterogeneous group of diseases. With the exception of granulomas induced by infectious agents or foreign bodies, the etiopathogenesis of granulomatous disorders is still poorly understood. The knowledge of histopathologic changes is of great importance for understanding clinical presentation and disease course.
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13
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Parikh SA, Que SKT, Holmes WD, Ferenczi K, Grant-Kels JM, Rothe MJ. Infiltrated papules on the trunk and headaches: A case of actinic granuloma and a review of the literature. Int J Womens Dermatol 2015; 1:131-135. [PMID: 28491976 PMCID: PMC5418885 DOI: 10.1016/j.ijwd.2015.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022] Open
Abstract
Actinic granuloma is a rare granulomatous reaction that is more commonly seen in females and thought to occur as an autoimmune response to actinic damage of elastic tissue. We discuss a case of a patient with actinic granuloma presenting with concomitant temporal arteritis. Our case and review of the literature emphasize the association between actinic granuloma and temporal arteritis, a serious inflammatory condition that could lead to blindness if misdiagnosed.
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Affiliation(s)
- Sonal A Parikh
- University of Connecticut Department of Dermatology, Farmington, CT.,Virginia Commonwealth University, Richmond, VA
| | | | - William D Holmes
- University of Connecticut Department of Dermatology, Farmington, CT.,Carle Foundation Hospital, Champaign, IL
| | - Katalin Ferenczi
- University of Connecticut Department of Dermatology, Farmington, CT
| | | | - Marti Jill Rothe
- University of Connecticut Department of Dermatology, Farmington, CT
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14
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Gutiérrez-González E, Pereiro M, Toribio J. Elastolytic Actinic Giant Cell Granuloma. Dermatol Clin 2015; 33:331-41. [DOI: 10.1016/j.det.2015.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Tronnier M, Mitteldorf C. Histologische Merkmale granulomatöser Hauterkrankungen: Teil 1: nichtinfektiöse granulomatöse Erkrankungen. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12610_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Tronnier
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS Klinikum Hildesheim
| | - Christina Mitteldorf
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS Klinikum Hildesheim
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16
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Granulomatous (Non-infectious) Diseases. Dermatopathology (Basel) 2014. [DOI: 10.1007/978-1-4471-5448-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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Berliner JG, Haemel A, LeBoit PE, Pincus LB. The sarcoidal variant of annular elastolytic granuloma. J Cutan Pathol 2013; 40:918-20. [DOI: 10.1111/cup.12237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anna Haemel
- Department of Dermatology; University of California San Francisco
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18
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Actinic Granuloma of the Conjunctiva in Young Women. Ophthalmology 2013; 120:1786-9. [DOI: 10.1016/j.ophtha.2013.01.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/25/2013] [Accepted: 01/30/2013] [Indexed: 11/24/2022] Open
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19
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Meyer A, Aaron D, Perry A, Guill M. Erythematous reticular patches: a rare presentation of mid-dermal elastolysis. J Am Acad Dermatol 2012; 67:e216-7. [PMID: 23062921 DOI: 10.1016/j.jaad.2012.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 03/28/2012] [Accepted: 03/30/2012] [Indexed: 10/27/2022]
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20
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Wee JS, Moosa Y, Misch K, Chong H, Natkunarajah J. Actinic granuloma: a history of photoexacerbation and the importance of a radial 'three-zone' biopsy. Clin Exp Dermatol 2012; 38:219-21. [PMID: 23020807 DOI: 10.1111/j.1365-2230.2012.04451.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J S Wee
- Department of Dermatology, Kingston Hospital, Surrey, UK.
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21
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Pacella F, Mazzeo F, Giorgi D, Cerutti F, Impallara D, Cuozzo G, Soldini M, Pacella E. Giant cell arteritis: the importance of immediate and appropriate diagnosis and treatment for better prognosis. Clin Ophthalmol 2012; 6:909-13. [PMID: 22791971 PMCID: PMC3392920 DOI: 10.2147/opth.s24572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This article describes the case of a 68-year-old patient suffering from giant cell arteritis (also known as Horton’s arteritis or temporal arteritis). The patient came to our attention due to a large and sudden visual loss caused by the occlusion of major retinal arteries. The patient had neuralgic pain in the face. The next day, for a thorough examination, the patient went to the day hospital with a further worsening of the visual loss which required immediate admission to the ophthalmological ward for hospitalization lasting 10 days. During the observation period it was difficult to make an instant diagnosis due to the absence of clinical signs or diagnostic tests for Horton’s arteritis. Only after the third day of hospitalization, when corticosteroid therapy was undertaken following the appearance of significant systemic symptoms, did the patient begin to show a gradual improvement in overall clinical status. The case highlights the difficulty in making a rapid diagnosis of giant cell arteritis and the efficacy of early steroid therapy in this vascular autoimmune disease that otherwise may result in irreversible functional and debilitating systemic damage.
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22
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Shoimer I, Wismer J. Annular Elastolytic Giant Cell Granuloma Associated with Temporal Arteritis Leading to Blindness. J Cutan Med Surg 2011; 15:293-7. [DOI: 10.2310/7750.2011.10042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous disorder characterized by giant cells in the dermis phagocytosing damaged elastin fragments. Objective: We report a case of a 71-year-old man presenting with erythematous plaques in predominantly sun-exposed areas. Method: A diagnosis of AEGCG was made based on the clinical and histologic picture, and treatment with systemic steroids was initiated. However, while tapering the steroid dose, the patient developed a radiating headache that progressed to temporal arteritis and eventual blindness in the right eye. Conclusion: There have been only two previous case reports presenting an association between AEGCG and temporal arteritis. This report explores AEGCG and its possible relationship to temporal arteritis along with possible treatment regimens cited in the current literature.
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Affiliation(s)
- Ilya Shoimer
- From the Department of Dermatology, McMaster University, Hamilton, ON
| | - Judy Wismer
- From the Department of Dermatology, McMaster University, Hamilton, ON
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23
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Wong S, Pearce C, Markiewicz D, Sahota A. Seasonal cutaneous sarcoidosis: a photo-induced variant. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:156-8. [DOI: 10.1111/j.1600-0781.2011.00579.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Hawryluk EB, Izikson L, English JC. Non-infectious granulomatous diseases of the skin and their associated systemic diseases: an evidence-based update to important clinical questions. Am J Clin Dermatol 2010; 11:171-81. [PMID: 20184390 DOI: 10.2165/11530080-000000000-00000] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Non-infectious granulomatous diseases of the skin are a broad group of distinct reactive inflammatory conditions that share important similarities. As a group, they are relatively difficult to diagnose and distinguish both clinically as well as histologically. Many of these disorders have significant associations with systemic diseases that impact the patient's overall prognosis. In this update, we offer a discussion of emerging concepts and controversies in this field, as presented through evidence-based answers to seven important clinical questions regarding palisading and epithelioid granulomata. These questions offer an opportunity to review ten non-infectious granulomatous conditions that have implications for systemic disease: granuloma annulare, annular elastolytic giant cell granuloma, necrobiosis lipoidica, methotrexate-induced accelerated rheumatoid nodulosis, necrobiotic xanthogranuloma, interstitial granulomatous dermatitis, interstitial granulomatous drug reaction, palisaded neutrophilic granulomatous dermatitis, sarcoidosis, and metastatic Crohn disease. Recent clinical, epidemiologic, and laboratory studies have shed some light on these diseases, the association of these conditions with systemic disorders, and their overall prognoses.
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Affiliation(s)
- Elena Balestreire Hawryluk
- Department of Dermatology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Actinic granuloma affecting the upper lip: a rare and challenging clinical entity. Br J Oral Maxillofac Surg 2010; 48:234-5. [DOI: 10.1016/j.bjoms.2009.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 08/23/2009] [Indexed: 10/20/2022]
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F8 - Granulome actinique d’O’Brien de présentation atypique. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)80078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stefanaki C, Panagiotopoulos A, Kostakis P, Stefanaki K, Petridis A. Actinic granuloma successfully treated with acitretin. Int J Dermatol 2005; 44:163-6. [PMID: 15689220 DOI: 10.1111/j.1365-4632.2005.02043.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Actinic granuloma is a rare skin disorder that develops in an area of actinic elastosis. The pathogenesis of the disease is obscure but the most accepted hypothesis implicates the solar radiation as the triggering factor. Typically the disease presents in middle-aged individuals with significant past sun-exposure and involves mainly the sun-exposed skin. It manifests as asymptomatic annular patches with elevated borders and central atrophy and shows little tendency to regression. Several treatments have been tried with variable success. We present a 74-year-old male who consulted our department for annular atrophic plaques involving his forehead and nose, present for 8 months and insidiously spreading but otherwise asymptomatic. A biopsy confirmed the clinical suspicion of actinic granuloma and excluded other possibilities. Our patient was commenced on acitretin 25 mg/day and showed a remarkable improvement within a year; the lesions stopped spreading and almost disappeared.
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Affiliation(s)
- C Stefanaki
- Third Department, Andreas Sygros Skin Hospital, Athens, Greece.
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Kelly BJ, Mrstik ME, Ramos-Caro FA, Iczkowski KA. Papular elastolytic giant cell granuloma responding to hydroxychloroquine and quinacrine. Int J Dermatol 2004; 43:964-6. [PMID: 15569034 DOI: 10.1111/j.1365-4632.2004.01735.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin J Kelly
- Division of Dermatology and Cutaneous Surgery, the Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Malcolm Randall Veterans Administration Medical Center, Gainesville, FL 32610-0277, USA
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Stefanaki C, Panagiotopoulos A, Kostakis P, Stefanaki K, Petridis A. Actinic granuloma successfully treated with acitretin. Int J Dermatol 2004. [DOI: 10.1111/j.1365-4632.2004.02043.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Limas C. The spectrum of primary cutaneous elastolytic granulomas and their distinction from granuloma annulare: a clinicopathological analysis. Histopathology 2004; 44:277-82. [PMID: 14987232 DOI: 10.1111/j.0309-0167.2004.01755.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Actinic granuloma (AG) and annular elastolytic giant cell granuloma (AEGCG) are terms commonly applied to cutaneous lesions characterized by elastolysis, elastophagocytosis and a multinucleated cell infiltrate. The aim of this study was to clarify the relationship of these lesions to granuloma annulare (GA) which they resemble clinically. METHODS AND RESULTS The clinicopathological data of 20 patients whose biopsies showed the histology of elastolytic granuloma as well as those of previously published cases with identical tissue changes were analysed to assess differences between AG, AEGCG and GA. The tissue changes of AG and AEGCG are identical and differ substantially from GA because of the predominant elastolysis and elastophagocytosis in the absence of necrobiosis and palisading granuloma. Actinic and/or thermal injury could be elicited frequently in the patient's history, but not always. CONCLUSIONS AG may be considered as an aetiopathological subdivision of AEGCG. Patients with biopsies showing both GA and AEGCG are occasionally encountered. AEGCG is easily differentiated from incidental elastolysis which may be seen in a variety of aetiologically unrelated processes.
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Affiliation(s)
- C Limas
- Department of Dermatopathology, Andreas Sygros Hospital, Athens, Greece
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Abstract
GREAT PROGRESS: The understanding of the physiopathology of Horton's syndrome has been made in view of the prevalence of the disease, the access to affected tissue and new molecular biology techniques. And it is now possible to specify the intricacy between the genetic, immunological and vascular components. HORTON'S SYNDROME, A GENETIC DISEASE: The preferential association of the disease with some alleles pf the HLA DR4 group has helped to emphasize the fundamental role of a few amino acids of the second hypervariable area of the HLA-DR molecule. An immunogenetic predisposition appears favourable, or even necessary, for the development of the disease. HORTON'S SYNDROME, AN IMMUNOLOGICAL DISEASE: The temporal arteries of patients presenting with Horton's syndrome are infiltrated by polymorphous inflammatory cells, fundamentally including CD4 T-cell lymphocytes, macrophages, and a few giant cells. Some CD4 lymphocytes have undergone clonal proliferation and show signs of recent antigenic recognition. A fraction of them secrete interferon gamma, which plays a crucial role in the onset, maintenance and orientation of the immunological response. The macrophages play multiple roles notably in maintaining the inflammatory reaction, but also in the destruction of certain structures of the arterial wall. HORTON'S SYNDROME, A VASCULAR DISEASE: The destruction of the arterial wall at the acute stage of the disease appears responsible, sometimes later on, for aneurismal dilatations observed on the aorta of certain patients. Moreover, intimal hyperplasia (mediated by the PDGF (platelet derived growth factor) A and B) and thrombosis (related to the inflammation) join up in reducing the arterial flow and enhancing the risk of ischemic complications during the acute stage. PATHOGENESIS, HYPOTHESES: Various candidate-antigens have been incriminated in the onset of the inflammatory reaction during Horton's syndrome. Some epidemiological and molecular studies are in favour of an exogenous antigen, possibly infectious, but no evidence has been demonstrated in the studies published. A parietal, endogenous antigen might also be at the origin of the cascade of events described during this disease.
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Bassas-Vila J, Umbert P, Iglesias M, Creus L. Granuloma actínico. Estudio clínico e histológico de cinco casos. ACTAS DERMO-SIFILIOGRAFICAS 2004. [DOI: 10.1016/s0001-7310(04)76857-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Al-Hoqail IA, Al-Ghamdi AM, Martinka M, Crawford RI. Actinic granuloma is a unique and distinct entity: a comparative study with granuloma annulare. Am J Dermatopathol 2002; 24:209-12. [PMID: 12140436 DOI: 10.1097/00000372-200206000-00004] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the initial description of actinic granuloma (AG), debate has continued over whether it should be considered a specific condition or simply granuloma annulare (GA) located in sun-exposed areas of skin. We conducted a case-control study to clarify this issue. Twenty cases given the diagnosis of AG between 1991 and 2001 were retrieved from our archives. We applied the following inclusion criteria: extensive loss of elastic tissue in or at the side of the granuloma, and elastophagocytosis. Sixteen cases of GA that involved sun-exposed and non-sun-exposed sites, 8 cases from each group, were randomly selected as controls. Histologic parameters were quantitated on hematoxylin-eosin, Verhoeff van Gieson, and Alcian blue stains for each case. Results were statistically analyzed by SPSS program version 9. Fourteen cases of AG met our inclusion criteria. Presence of mucin, occurrence of multinucleated giant cells, and the type of granulomata were of high statistical significance (p < 0.01) in distinguishing the two entities. We also found that the location of the granulomata in these conditions is different and of statistical significance (p < 0.05). Based on histomorphology, we believe that AG should be considered a separate, independent condition and should be distinguished from GA even in sun-exposed areas of skin.
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