背景:环状肉芽肿是一种以红斑或皮肤着色环状斑块为特征的非感染性炎症性肉芽肿性皮肤病。环状肉芽肿的诊断可能由于其形态多样而具有挑战性。在这种情况下,临床发现和组织学发现之间的相关性是必要的.
方法:我们报告一例纯化蛋白衍生物给药后出现环状肉芽肿。一名56岁的白人女性患者抱怨轻度瘙痒性皮疹,始于手臂和下肢,并最终蔓延到两股大腿,左边的the区,左上后背,和右腹部区域。在皮疹爆发前大约6周,患者接受了纯化蛋白衍生物结核菌素皮肤试验。活检标本显示真皮组织细胞在粘蛋白和变性胶原区域周围出现,确认环状肉芽肿.用0.1%局部曲安奈德和500mg口服甲硝唑治疗后,患者的病变消退。
结论:对环状肉芽肿的确切病因知之甚少。环状肉芽肿有四种变异,表现为局部化,广义的,皮下,或穿孔和环状肉芽肿。环状肉芽肿的临床预后因临床亚型而异。提出的皮下肉芽肿环状的因果机制包括物理创伤,感染,免疫接种,昆虫叮咬,糖尿病,以及细胞介导的免疫反应的改变。该疾病可能具有炎症成分。临床上,环状肉芽肿可能与许多其他皮肤病相混淆。
结论:该病例为环状皮下肉芽肿,是一种罕见的皮肤病病理状况,可与其他皮疹疾病相混淆。虽然它是一种良性的自限性疾病,明确诊断对于排除具有相似临床表现的其他病理很重要,例如癌症或人类免疫缺陷病毒(HIV)感染。诊断确认最好通过皮肤活检。
BACKGROUND: Granuloma annulare is a noninfectious inflammatory granulomatous skin disease characterized by an erythematous or skin colored annulare plaque. The diagnosis of granuloma annulare may be challenging owing to its diverse morphology. In such cases, a correlation between the clinical findings and histologic findings are necessary.
METHODS: We report a case of granuloma annulare after purified protein derivative administration. A 56-year-old Caucasian female patient complained of mildly pruritic rashes which started on both arms and lower extremities, and eventually spread to both thighs, the left popliteal region, left upper back, and the right abdominal area. About 6 weeks prior to the eruption of the rashes, the patient had been given a purified protein derivative tuberculin skin test. Biopsy specimens revealed dermal histiocytes palisading around areas of mucin and degenerated collagen, confirming granuloma annulare. After treatment with 0.1% topical triamcinolone acetanide and 500 mg oral metronidazole, the patient\'s lesions resolved.
CONCLUSIONS: Relatively little is known about granuloma annulare\'s exact etiology. Granuloma annulare has four variations presenting as either localized, generalized, subcutaneous, or perforating and patch granuloma annulare. The clinical prognosis for granuloma annulare varies according to clinical subtypes. Proposed causal mechanisms of subcutaneous granuloma annulare include physical trauma, infections, immunizations, insect bites, diabetes mellitus, and alterations in the cell-mediated immune responses. The disease likely has an inflammatory component. Clinically, granuloma annulare may be confused with many other skin diseases.
CONCLUSIONS: This case of subcutaneous granuloma annulare was reported since it is a rare dermatologic pathological condition that can be confused with other skin rash disorders. Although it is a benign self-limited disease, definitive diagnosis is important to rule out other pathologies with similar clinical appearances, such as cancer or human immunodeficiency virus (HIV) infection. Diagnostic confirmation is best made through skin biopsy.