Granuloma Annulare Mimicking Sarcoidosis: Report of Patient With Localized Granuloma Annulare Whose Skin Lesions Show 3 Clinical Morphologies and 2 Histology Patterns.

Granuloma annulare, a benign dermatosis of undetermined etiology, typically presents in a localized or generalized form. It has 3 distinctive histologic patterns: an infiltrative (interstitial) pattern, a palisading granuloma pattern, and an epithelioid nodule (sarcoidal granuloma) pattern. A man whose granuloma annulare skin lesions mimicked sarcoidosis is described. His localized granuloma annulare presented with a total of 3 lesions that each had a distinctive clinical morphology: an annular lesion of individual papules, a dermal nodule, and a linear arrangement of 3 papules. Two of his lesions showed a palisading granuloma histology pattern of granuloma annulare; however, the linear papules on his posterior neck lesion demonstrated noncaseating granulomas consistent with either the epithelioid nodule histology pattern of granuloma annulare or sarcoidal granuloma compatible with sarcoidosis. A comprehensive evaluation excluded the diagnosis of systemic sarcoidosis. Using the PubMed database, an extensive literature search was performed on granuloma annulare, epithelioid nodule, sarcoidal granuloma, and sarcoidosis. The histology patterns of granuloma annulare-emphasizing the history and differentiating features of the epithelioid nodule pattern from cutaneous sarcoidosis-were reviewed. The epithelioid nodule (sarcoidal granuloma) histology pattern of granuloma annulare is uncommon and may mimic the histology changes observed in sarcoidosis skin lesions; the absence of asteroid or other giant cell inclusions and an increase in mucin deposition between the collagen bundles favor the diagnosis of granuloma annulare. In addition, the epithelioid nodule pattern of granuloma annulare can rarely also show other histologic patterns of granuloma annulare in the same biopsy specimen or concurrently present with other clinical lesions of granuloma annulare that demonstrate a palisading granuloma, or possibly an infiltrative, histology pattern. However, the presence of an isolated skin lesion demonstrating sarcoidal granulomas--even when concurrently appearing with other lesions of granuloma annulare showing either an infiltrative or a palisading granuloma histologic pattern--may prompt the clinician to evaluate and exclude the possibility of systemic sarcoidosis.

Panniculitis in children.

This paper will give a comprehensive view of the most frequent panniculitides seen in childhood, with emphasis on the types exclusively found in infancy, and for all other types of panniculitides also found in adults. Aim of this paper is also to analyze the clinical differences between panniculitis in childhood and in adulthood, and to give reliable histopathologic criteria for a specific diagnosis. A review of the literature is here integrated by authors' personal contribution. Panniculitides in children is a heterogeneous group of diseases, as well as in adult life, characterized by inflammation of the subcutaneous fat. Only very few types of panniculitis are exclusively found in childhood, such as Sclerema neonatorum and subcutaneous fat necrosis of the newborn, while the vast majority of the other types may be found both in paediatric age and in adults. Furthermore, this paper will consider in detail panniculitis according to their frequency, such as Erythema nodosum, Lupus panniculitis, Cold panniculitis, panniculitis in Behçet disease, and poststeroid panniculitis. It will also describe rare forms of panniculitis, such as Eosinophilic panniculitis (a pathological entity debated by many authors), Subcutaneous panniculitis T-cell lymphoma, and the different forms of the so call "Lipophagic panniculitis", encompassing respectively the febrile relapsing panniculitis of Weber-Christian disease and the non-relapsing form of Rothmann-Makai disease. For each type of panniculitis considered concise information will be given about epidemiology, etiology, clinical findings, laboratory data, prognosis and therapy, while histopathologic findings will be described in detail.

Dyslipidemia in granuloma annulare: a case-control study.

OBJECTIVES: To estimate the prevalence of dyslipidemia (DLP) among individuals with idiopathic granuloma annulare and to examine associations with disease characteristics and comorbidities, such as metabolic syndrome. DESIGN: Case-control study using review of medical records from January 2002 through December 2010. SETTING: A university hospital and a health care system. PARTICIPANTS: Adults consisting of 140 patients and 420 individuals serving as controls matched for age, sex, race/ethnicity, hypertension, type 2 diabetes mellitus, and hypothyroidism. MAIN OUTCOME MEASURES: Prevalence of DLP and its associated components (hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol) in idiopathic granuloma annulare, as well as odds ratio of DLP after adjusting for confounding variables. RESULTS: The prevalence of DLP was 79.3% among granuloma annulare cases and 51.9% among controls (P.001). Granuloma annulare was associated with DLP (odds ratio, 4.04;95%CI,2.53-6.46) after adjusting for confounding variables. Statistically significant differences between patient and control groups were found for levels of total cholesterol, triglycerides, and low-density lipoprotein cholesterol (P.001 for all variables). A statistically significant association between the extent of disease and DLP (P=.02) was shown. Annular lesion morphology was associated with hypercholesterolemia (P=.02) and DLP (P=.01). CONCLUSIONS: This study indicates an association between granuloma annulare and DLP. Dyslipidemia is more common in generalized than in localized/disseminated disease, and the annular lesion morphology is associated with hypercholesterolemia and DLP. Physicians should be aware of these important associations and consider them in the management of granuloma annulare.

Granuloma annulare anterior uveitis.

PURPOSE: To present a case of bilateral granuloma annulare anterior uveitis. DESIGN: Case report. METHODS: Clinical case presentation and review of literature. RESULTS: A 72-year-old woman with a history of granuloma annulare (GA) presented with acute bilateral granulomatous anterior uveitis. General physical exam revealed hypo- and hyper-pigmented punctate and annular skin lesions on both arms characteristic of GA. Infectious and autoimmune workup revealed a mildly elevated angiotensin converting enzyme (ACE) level. Her uveitis resolved with topical prednisolone and homatropine. CONCLUSIONS: Granuloma annulare is a rare cause of anterior uveitis that is diagnosed by characteristic skin findings and may be associated with sarcoidosis.

Low serum insulin values in children with multiple lesions of granuloma annulare: a prospective study.

BACKGROUND: The relationship between granuloma annularae (GA) and diabetes mellitus (DM) is controversial. OBJECTIVE: To investigate the relationship between multiple lesions of GA and carbohydrate metabolism in children. SUBJECTS AND METHODS: Fifteen children (seven boys, eight girls, mean age 4.8 years) with five or more lesions of GA were evaluated. A personal and family history of DM or other autoimmune diseases was obtained and the glycaemic and insulin response during an oral glucose tolerance test (OGTT) was determined. Thirteen children with a negative personal and family history of DM served as controls for the OGTT and 100 other children as 'clinical controls'. RESULTS: At the 30-min sampling of the OGTT the mean insulin values were comparable in GA children and controls (P=0.1), while the mean glucose values were significantly higher in GA children than in controls (P=0.005). All other insulin values during the OGTT were significantly lower in GA children than in controls, while all other glucose values were comparable in GA children and controls with all indices applied. Eleven out of 15 GA children had a positive family history of DM (73.3% vs. 16% of the clinical controls; P<0.0001). CONCLUSION: Multiple lesions of GA in children are associated with significantly lower serum insulin values than in controls and mildly impaired glucose tolerance.