Korean J Dermatol.  2017 Dec;55(10):684-688.

Palisaded Neutrophilic and Granulomatous Dermatitis Manifested as a LE-nonspecific Skin Lesion

• Kim TH
• Seo JW
• Choi SH
• Song KH
• Kim KH

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.

Keyword

Palisaded neutrophilic and granulomatous dermatitis; PNGD; Systemic lupus erythematosus

MeSH Terms

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
Antibodies, Antinuclear
Collagen
Fibrin
Glycoproteins
Hydroxychloroquine
Lupus Coagulation Inhibitor
Mucins
Tacrolimus