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Sarıkaya Tellal E, Ilhan Erdil D, Gore Karaali M, Aksu AEK, Erdemir VA, Polat AK, Leblebici C. Interstitial Granulomatous Dermatitis and Palisaded Neutrophilic Granulomatous Dermatitis: Retrospective Clinicopathological Analysis of 16 Cases. Dermatol Pract Concept 2023; 13:e2023129. [PMID: 37557159 PMCID: PMC10412059 DOI: 10.5826/dpc.1303a129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Reactive granulomatous dermatitis (RGD) is a new entity, which is highly associated with systemic disorders. There is scarce data regarding interstitial granulomatous dermatitis (IGD) and palisaded neutrophilic granulomatous dermatitis (PNGD). OBJECTIVES We aimed to evaluate clinical and histopathological characteristics of IGD and PNGD as unified entities under the term of RGD. METHODS Observational, retrospective, single-center study of patients diagnosed with IGD and PNGD between 2012 and 2021 were included in the study. RESULTS Of 16 patients (14 females and 2 males) with RGD, 13 had IGD and 3 had PNGD with a mean age of 62.5 years. The most common clinical presentation was plaques 37.5% (N=6), followed by patches 25% (N=4). The most common localization of involvement was lower extremity 75% (N=12), followed by trunk and upper extremity. Multiple localization of involvement was determined in 75% (N=12) of patients. None of the patients had rope sign. Associated comorbidities such as autoimmune diseases and malignancies were detected in 68.7% (N=11) of patients. In majority of biopsies (87.5%; N=14), there were lymphohistiocytic cell infiltration. Other accompanying cells were scarce neutrophils 31.2% (N=5) and eosinophils 31.2% (N=5). All of the biopsies had interstitially located lymphohistiocytic cell infiltration surrounding with swollen and degenerated collagen. Palisaded pattern was determined in 18.7% (N=3) of patients and floating sign was seen in 18.7% (N=3) of biopsies. CONCLUSIONS RGD is a rare entity and most patients with RGD had associated disorders such as autoimmunity or malignancy. There is overlapping between IGD and PNGD, therefore supporting the usage of umbrella term as reactive granulomatous dermatitis is compatible with the literature.
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Affiliation(s)
- Ebru Sarıkaya Tellal
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Dilara Ilhan Erdil
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Muge Gore Karaali
- Department of Dermatology, Irmet International Hospital, Tekirdag, Turkey
| | - Ayse Esra Koku Aksu
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - VA Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Asude Kara Polat
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
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Shin YB, Jo JW, Yoon TJ. Palisaded Neutrophilic and Granulomatous Dermatitis in a Patient with Behçet's Disease: A Case Report. Ann Dermatol 2020; 33:73-76. [PMID: 33911815 PMCID: PMC7875227 DOI: 10.5021/ad.2021.33.1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/07/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon skin eruption and characterized histopathologically by the presence of granulomatous inflammation with or without leukocytoclastic vasculitis. PNGD is known to be associated with various immune-mediated connective tissue diseases such as rheumatoid arthritis and lupus erythematosus. However, to our knowledge, a case of PNGD in a patient with Behçet's disease is extremely rare and only one case has been reported in foreign literature to date. Herein, we report an unusual case of a 60-year-old female with Behçet's disease who presented multiple erythematous to flesh-colored papules on the extremities, buttocks, and ear lobes and was diagnosed with PNGD. After the treatment of systemic corticosteroids, colchicine and azathioprine, the skin lesions and oral ulcers improved. The patient is under observation without recurrence of skin lesions for 6 months.
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Affiliation(s)
- Young-Bin Shin
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jeong-Won Jo
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Tae-Jin Yoon
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea.,Gyeongsang Institute of Health Sciences, Jinju, Korea
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Fernandez-Flores A, Hermosa-Gelbard A, Pérez A, Bello JA, Cabo F. Scarring alopecia in chronic cutaneous lupus erythematosus with neutrophils: A new scenario with therapeutic connotations. J Cutan Pathol 2020; 47:976-982. [PMID: 32483922 DOI: 10.1111/cup.13764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
The relationship between autoinflammatory and autoimmune conditions has been demonstrated in recent decades. Several autoimmune conditions exhibit an autoinflammatory component, which can manifest in various ways. Neutrophilic dermatosis in the context of lupus erythematosus (LE) is one example. Otherwise, neutrophils are rare in LE, except for the bullous variant and nonbullous neutrophilic LE. In this paper, we describe a case of scarring alopecia due to LE that stopped responding to a treatment that had been effective for years. The biopsy specimen demonstrated the presence of neutrophils in the inflammatory infiltrate. A treatment with dapsone was prescribed and yielded rapid improvement. This first case of scarring alopecia in the context of nonbullous neutrophilic LE emphasizes the importance of the infiltrate in determining the optimal therapeutic choice.
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Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain.,Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain.,Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC) A Coruña, Spain
| | - Angela Hermosa-Gelbard
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Dermatology Department, Hospital Universitario Quirón San José, Madrid, Spain.,Dermatology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Alberto Pérez
- Department of Anatomic Pathology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - José Antonio Bello
- Department of Anatomic Pathology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Fernando Cabo
- Department of Dermatology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
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Stiff KM, Cohen PR. Palisaded Granulomatous Dermatitis Associated with Ulcerative Colitis: A Comprehensive Literature Review. Cureus 2017; 9:e958. [PMID: 28168136 PMCID: PMC5293147 DOI: 10.7759/cureus.958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Palisaded granulomatous dermatitis is an uncommon pathologic condition potentially associated with several disorders. These include drugs, inflammatory bowel disease, multiple myelomas, rheumatoid arthritis, and systemic lupus erythematosus. An illustrative case of a man with palisaded granulomatous dermatitis who subsequently developed ulcerative colitis is described, and the characteristics of other individuals with ulcerative colitis-associated palisaded granulomatous dermatitis are reviewed. PubMed was used to search the following terms: palisaded, interstitial, granulomatous, dermatitis, ulcerative colitis, and neutrophilic. Papers were obtained and references were reviewed. Ulcerative colitis-associated palisaded granulomatous dermatitis is uncommon. Palisaded granulomatous dermatitis-associated ulcerative colitis has been reported in four individuals. The palisaded granulomatous dermatitis appeared from six years prior to diagnosis to 19 years following diagnosis of the patient’s gastrointestinal disease. In addition to individual and grouped papular lesions on the elbows, the morphology of palisaded granulomatous dermatitis can also present as indurated linear plaques overlying the metacarpophalangeal (MCP) joints and proximal fingers.
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Affiliation(s)
| | - Philip R Cohen
- Department of Dermatology, University of California, San DIego
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Rosenbach M, English JC. Reactive Granulomatous Dermatitis: A Review of Palisaded Neutrophilic and Granulomatous Dermatitis, Interstitial Granulomatous Dermatitis, Interstitial Granulomatous Drug Reaction, and a Proposed Reclassification. Dermatol Clin 2015; 33:373-87. [PMID: 26143420 DOI: 10.1016/j.det.2015.03.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The terms "palisaded neutrophilic and granulomatous dermatitis," "interstitial granulomatous dermatitis," and the subset "interstitial granulomatous drug reaction" are a source of confusion. There exists substantial overlap among the entities with few strict distinguishing features. We review the literature and highlight areas of distinction and overlap, and propose a streamlined diagnostic workup for patients presenting with this cutaneous reaction pattern. Because the systemic disease associations and requisite workup are similar, and the etiopathogenesis is poorly understood but likely similar among these entities, we propose the simplified unifying term "reactive granulomatous dermatitis" to encompass these entities.
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Affiliation(s)
- Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Joseph C English
- University of Pittsburgh, Department of Dermatology, UPMC North Hills Dermatology, Wexford, PA, USA
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Abstract
Neutrophilic dermatoses constitute a heterogeneous group of dermatologic diseases, which are unified by the predominance of neutrophils within the inflammatory infiltrate on histopathology. The aims of this review were to provide an update on the clinical and histologic presentation of the main neutrophilic dermatoses and to develop a guide for clinical practice. A structured literature search of PubMed, Medline, and Embase was performed, using the key words "neutrophilic disorders", "cutaneous small vessel vasculitis", "Sweet's syndrome", "bowel associated dermatosis arthritis syndrome", "Behcet's", "palisaded neutrophilic and granulomatous dermatosis", "rheumatoid neutrophilic dermatitis", and "pyoderma gangrenosum". Related articles were screened for key terms and were included if appropriate. This group contains a wide spectrum of unique disorders, each with its own histologic and clinical subtleties, making specific diagnosis of a given entity within the group diagnostically challenging. The fact that overlapping forms of neutrophilic dermatoses, which share features of multiple neutrophilic dermatoses, are not uncommon makes the diagnoses more challenging.
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Scheerens H, Su Z, Irving B, Townsend MJ, Zheng Y, Stefanich E, Chindalore V, Bingham CO, Davis JC. MTRX1011A, a humanized anti-CD4 monoclonal antibody, in the treatment of patients with rheumatoid arthritis: a phase I randomized, double-blind, placebo-controlled study incorporating pharmacodynamic biomarker assessments. Arthritis Res Ther 2011; 13:R177. [PMID: 22029963 PMCID: PMC3308112 DOI: 10.1186/ar3502] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/07/2011] [Accepted: 10/26/2011] [Indexed: 11/22/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of the humanized anti-CD4 monoclonal antibody MTRX1011A in a randomized, double-blind placebo-controlled Phase 1 study in patients with rheumatoid arthritis (RA). Methods In the single ascending dose (SAD) portion of the study, patients received single doses of a placebo or MTRX1011A at 0.3, 1.0, 3.5 and 7.0 mg/kg intravenously (IV) or 1.0 and 3.5 mg/kg subcutaneously (SC), followed by five weeks of evaluation. In the multi-dose (MD) portion of the study, placebo or MTRX1011A was administered weekly for eight doses at 1.5 or 3.5 mg/kg SC, or 5 mg/kg IV, followed by eight weeks of evaluation. Results MTRX1011A was well tolerated in the SAD phase up to 7 mg/kg IV and in the MD phase up to 1.5 mg/kg SC. At weekly doses of 3.5 mg/kg SC and 5 mg/kg IV, a moderate pruritic papular rash was observed in some MTRX1011A-treated patients, which was considered a dose-limiting toxicity for this clinical indication. No serious adverse events occurred in any cohort. Reduction in disease activity was modest. PD assessments demonstrated that MTRX1011A induced a dose-dependent down-modulation of CD4 expression on peripheral blood CD4 T cells, CD4 receptor occupancy, increases in serum sCD4-MTRX1011A complexes and up-regulation of CD69 on T cells, but was non-depleting. Conclusions The maximum tolerated dose of MTRX1011A was 1.5 mg/kg SC administered weekly. At this dose MTRX1011A did not achieve maximum PD activity expected to be required for reduction in disease activity.
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Affiliation(s)
- Heleen Scheerens
- Genentech Research and Early Development, 1 DNA Way, South San Francisco, CA 94080, USA
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Gordon EA, Schmidt AN, Boyd AS. Palisaded neutrophilic and granulomatous dermatitis: A presenting sign of sarcoidosis? J Am Acad Dermatol 2011; 65:664-665. [DOI: 10.1016/j.jaad.2010.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/14/2010] [Accepted: 05/20/2010] [Indexed: 11/29/2022]
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Mahmoodi M, Ahmad A, Bansal C, Cusack CA. Palisaded neutrophilic and granulomatous dermatitis in association with sarcoidosis. J Cutan Pathol 2010; 38:365-8. [PMID: 20528967 DOI: 10.1111/j.1600-0560.2010.01560.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Palisaded and neutrophilic granulomatous dermatitis (PNGD) has been associated with many conditions including rheumatoid arthritis, systemic lupus erythematosus, systemic vasculitis, and other diseases with circulating immune complexes. Lymphoproliferative conditions, bacterial endocarditis, and various drugs can also induce this condition. Many patients also have symmetric polyarthritis with various serological abnormalities. We present a case of a 46-year-old female who presented with painful erythematous annular plaques and nodules on her legs. The lesions started a week prior to visit and increased in number over the course of the week. The patient had an established history of sarcoidosis with past episodes of uveitis and erythema nodosum. The histopathological findings included a diffuse pandermal infiltrate mostly composed of neutrophils, nuclear debris, and strands of deeply eosinophilic degenerated collagen. Vasculitis was not present. No significant increase in dermal mucin was detected. Based on the clinical and pathological findings, the patient was diagnosed with late-stage PNGD. To our knowledge, this is the first case of PNGD described in an adult patient of sarcoidosis.
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Affiliation(s)
- Mandana Mahmoodi
- Department of Dermatology, Tufts Medical Center and Caris/Cohen Dx, Boston, MA 02464, USA.
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Abstract
The neutrophilic dermatoses are rare disorders, especially in children, and are characterized by neutrophilic infiltrates in the skin and less commonly in extracutaneous tissue. The neutrophilic dermatoses share similar clinical appearances and associated conditions, including inflammatory bowel disease, malignancies, and medications. Overlap forms of disease demonstrating features of multiple neutrophilic dermatoses may be seen. The manuscript attempts to provide an up-to-date review of (i) classical neutrophilic dermatoses, focusing on distinctive features in children and (ii) neutrophilic dermatoses which may largely be pediatric or genodermatosis-associated (Majeed, SAPHO [synovitis, severe acne, sterile palmoplantar pustulosis, hyperostosis, and osteitis] syndrome, PAPA (pyogenic sterile arthritis, pyoderma gangrenosum, and acne), PFAPA (periodic fever with aphthous stomatitis, pharyngitis, and cervical adenopathy), and other periodic fever syndromes, and congenital erosive and vesicular dermatosis healing with reticulated supple scarring).
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Affiliation(s)
- David R Berk
- Department of Internal Medicine, Division of Dermatology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri, USA.
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Palisaded neutrophilic and granulomatous dermatitis associated with limited systemic sclerosis. J Am Acad Dermatol 2008; 58:661-4. [DOI: 10.1016/j.jaad.2007.09.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 09/06/2007] [Accepted: 09/19/2007] [Indexed: 11/23/2022]
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Moloney FJ, Hayden J, Sheahan K, Collins P. Bilateral lower limb erythematous papules with myalgia. Clin Exp Dermatol 2007; 32:475-6. [PMID: 17263832 DOI: 10.1111/j.1365-2230.2007.02356.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- F J Moloney
- Department of Dermatology, St Vincent's Hospital, Dublin, Ireland.
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Bibliography. Current world literature. Vasculitis syndromes. Curr Opin Rheumatol 2006; 19:81-5. [PMID: 17143101 DOI: 10.1097/bor.0b013e32801437a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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