Annals of dermatology

Korean Dermatological Association (대한피부과학회)
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Perforating Granuloma Annulare Mimicking Papulonecrotic Tuberculid

  • Chae, Myeong Heon (Department of Dermatology, Medical Research Institute, Chungbuk National University School of Medicine) ;
  • Shin, Jee Yon (Department of Dermatology, Medical Research Institute, Chungbuk National University School of Medicine) ;
  • Lee, Ji Yeoun (Department of Dermatology, Medical Research Institute, Chungbuk National University School of Medicine) ;
  • Yoon, Tae Young (Department of Dermatology, Medical Research Institute, Chungbuk National University School of Medicine)
  • Received : 2018.03.14
  • Accepted : 2018.05.19
  • Published : 2018.12.01
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Abstract

Perforating granuloma annulare (PGA), a rare variant of granuloma annulare, is characterized by transepidermal elimination of altered collagen that clinically manifests an umbilicated papule with a central crust. It can be confused with papulonecrotic tuberculid (PNT) because of their similar appearance. Unlike PGA, PNT is usually related to tuberculosis infection with a typical histologic finding of wedgeshaped dermal necrosis. Here, we report the first Korean case of PGA mimicking PNT both clinically and histologically. A 43-year-old Korean woman presented with erythematous papules localized on the extensor surface of her limbs for one year. Some of these papules had a central umbilication or a crust. Regarding comorbidity, she had latent tuberculosis diagnosed with $QuantiFERON^{(R)}-TB$ Gold test about five months ago. She was on antituberculous medication. Initially, a diagnosis of papulonecrotic tuberculid accompanied by latent tuberculosis was considered. However, despite taking the antituberculous medication for five months, her skin lesions were not improved. Biopsy specimen from her arm lesion showed wedge-shaped area of necrosis in the dermis. Additionally, there were multiple focal mucin depositions and palisading granulomatous inflammation throughout the dermis. A diagnosis of PGA was made and she was treated with topical corticosteroid. After two weeks of applying topical corticosteroid, most of her skin lesions disappeared, leaving some hyperpigmented scars.

Keywords

References

  1. Piette EW, Rosenbach M. Granuloma annulare: clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol 2016;75:457-465. https://doi.org/10.1016/j.jaad.2015.03.054
  2. Tirumalae R, Yeliur IK, Antony M, George G, Kenneth J. Papulonecrotic tuberculid-clinicopathologic and molecular features of 12 Indian patients. Dermatol Pract Concept 2014;4:17-22.
  3. Samlaska CP, Sandberg GD, Maggio KL, Sakas EL. Generalized perforating granuloma annulare. J Am Acad Dermatol 1992;27:319-322. https://doi.org/10.1016/0190-9622(92)70190-Q
  4. Penas PF, Jones-Caballero M, Fraga J, Sanchez-Perez J, Garcia-Diez A. Perforating granuloma annulare. Int J Dermatol 1997;36:340-348. https://doi.org/10.1046/j.1365-4362.1997.00047.x
  5. Seong YK, Cho KH, Kim SH, Lee YS. A case of perforating granuloma annulare. Korean J Dermatol 1986;24:679-682.
  6. Hong KT, Lee KH, Park CI. A case of generalized perforating granuloma annulare. Korean J Dermatol 1988;26:560-564.
  7. Lee JD, Yi JY, Cho BK, Houh W. Anetoderma due to generalized perforating granuloma annulare. Ann Dermatol 1990;2:96-99. https://doi.org/10.5021/ad.1990.2.2.96
  8. Yoon SY, Kim KH, Suhr KB, Park JK. A case of generalized granuloma annulare with perforating and subcutaneous granuloma annulare. Korean J Dermatol 1995;33:1119-1123.
  9. Lee SY, Han KP, Choi KC, Kim YK. A case of disseminated perforating granuloma annulare in a child. Ann Dermatol 1996;8:223-226. https://doi.org/10.5021/ad.1996.8.3.223
  10. Lee SW, Lee IW, Lee YS, Lee SC. Generalized perforating granuloma annulare. Korean J Dermatol 2000;38:1248-1249.
  11. Koh BK, Park CJ, Yi JY, Cho BK. A case of generalized perforating granuloma annulare with diabetes mellitus. Korean J Dermatol 2001;39:491-493.
  12. Owens DW, Freeman RG. Perforating granuloma annulare. Arch Dermatol 1971;103:64-67. https://doi.org/10.1001/archderm.1971.04000130066010
  13. Wilson-Jones E, Winkelmann RK. Papulonecrotic tuberculid: a neglected disease in Western countries. J Am Acad Dermatol 1986;14:815-826. https://doi.org/10.1016/S0190-9622(86)70099-6
  14. Pereira AR, Vieira MB, Monteiro MP, Enokihara MM, Michalany NS, Bagatin E, et al. Perforating granuloma annulare mimicking papulonecrotic tuberculid. An Bras Dermatol 2013;88(6 Suppl 1):101-104. https://doi.org/10.1590/abd1806-4841.20132510
  15. Yu JC, Lee KC. Generalised perforating granuloma annulare mimicking papulonecrotic tuberculid. Hong Kong J Dermatol Venereol 2006;14:139-142.
  16. Woo TY, Rasmussen JE. Disorders of transepidermal elimination. Part 2. Int J Dermatol 1985;24:337-348. https://doi.org/10.1111/j.1365-4362.1985.tb05494.x

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