sQuiz your knowledge: Asymptomatic, bilateral, annular plaques
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ychloroquine (200 mg/d), methotrexate (15 mg/w) and prednisolone (5 mg/d), was referred for evaluation of asymptomatic lesions that appeared spontaneously during the summer (figure 1A). Physical examination showed bilateral erythematous plaques on the thighs with palpable serpiginous borders. Histopathological findings revealed an histiocytic interstitial infiltrate in the reticular and deep dermis, an absence of vasculitis and granulomas surrounding condensed collagen fibres (figure 1B).
A 52-year-old woman, with a medical history of systemic lupus erythematosus successfully treated with hydrox-
What is your diagnosis?
sQuiz your knowledge: Asymptomatic, bilateral, annular plaques Merryl LAMOTTE1 , Fanny DOR2 , Franc¸ois AUBIN1 1 2
A
B
Figure 1. A) Two asymptomatic plaques at the root of the thighs. B) Histiocytic interstitial infiltrate in the reticular and deep dermis, and granulomas surrounding condensed collagen fibres (haematoxylin, eosin and saffron staining; x400).
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EJD, vol. 30, n◦ 4, July-August 2020
Interstitial granulomatous dermatitis
Department of dermatology, Charles Nicolle Hospital, Tunis, Tunisia [email protected]
Interstitial granulomatous dermatitis (IGD) is a rare dermatosis first described by Ackerman in 1993 [1]. IGD is characterized by erythematous to violaceous patches or plaques, symmetrically located on the upper trunk and proximal limbs. Although linear subcutaneous cords or bands, known as the “rope sign”, were initially considered pathognomic, this finding has only been reported in less than 10% of cases [2]. Arthritis is also an inconsistent feature, which may occur prior to, simultaneously with, or after the onset of the cutaneous lesions. Diagnosis is confirmed by histological findings showing palisading or interstitial CD68+ histiocytes, a variable number of neutrophils and eosinophils, and scattered areas of degenerating collagen bundles [2, 3]. The pathogeny of IGD is unclear and it may belong to the same spectrum of palisaded and neutrophilic granulomatous dermatitis [4]. IGD is frequently associated with autoimmune diseases such as rheumatoid arthritis, or neoplasia and hemopathy. Iatrogenic origin is common, especially with beta-blockers, ACE inhibitors, anti-TNF␣ drugs, and more recently, immune checkpoint inhibitors [5, 6]. Spontaneous regression is slow and uncertain, and the treatment is still poorly codified even though satisfactory results have been obtained with topical or systemic corticosteroids, methotrexate, cyclosporin or immunoglobulins [3].
A 15-year-old boy was referred to our hospital with severe anaemia, cachexia, dehydration, bloated abdomen, recurrent diarrhoea, a photosensitive rash on sun-exposed areas of the body, and depressive symptoms including apathy and early morning insomnia. The patient was reported to be suffering from Crohn’s disease complicated by exudative enteropathy and intestinal malabsorpation. Clinical examination revealed hypotension, tachycardia, cardiac functional murmur, and hyperkeratotic symmetrical plaques su
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