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Seminars in Arthritis and Rheumatism
Volume 34, Issue 3,
, Pages 610-616
Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon skin eruption most often associated with rheumatoid arthritis and other immune-mediated diseases. We present 4 cases to familiarize rheumatologists with the clinical presentation and histopathology of PNGD.
We report 4 cases to illustrate the clinical and histologic spectrum of this rare skin disease found in rheumatologic patients. The disease pathogenesis and treatment options are discussed.
All 4 patients presented with symmetric erythematous-to-violaceous papules and plaques that, upon biopsy, revealed a dermatitis composed of variable numbers of histiocytes and neutrophils. Some cases responded to topical corticosteroid treatment or to dapsone, whereas others resolved spontaneously.
PNGD is a rare cutaneous finding in patients with a variety of immune-mediated systemic diseases, most often rheumatoid arthritis. It is a benign condition that may spontaneously remit or may respond favorably to topical corticosteroids or dapsone.
A 57-year-old woman with seronegative rheumatoid arthritis of 6 years’ duration presented with a 3-week history of a slightly pruritic eruption on her medial thighs, back, and shoulders. She also complained of worsening arthritis, with development of effusions in her knees. She had been treated with methotrexate and started infliximab therapy 3 months before the eruption. She was referred to the dermatology department because of concerns that her skin eruption might represent a drug reaction,
Very likely, the first cases of PNGD were described in 1965 by Dykman et al. They reported 2 cases of patients with rheumatoid arthritis who developed linear cords on the lateral trunk (7). Biopsy of these cords showed an interstitial granulomatous dermatitis with lymphocytes and neutrophils, as well as areas of degenerated collagen. They depicted this as an “unusual form of rheumatoid granuloma.” Gottlieb et al later described the histopathologic characteristics of similar linear cords in
- T.S. Brown et al.Rheumatoid neutrophilic dermatitis in a woman with seronegative rheumatoid arthritis
J Am Acad Dermatol
- M.L. Smith et al.Rheumatoid papuleslesions showing features of vasculitis and palisading granuloma
J Am Acad Dermatol
- Y. Higaki et al.Rheumatoid papulesa report on four patients with histopathologic analysis
J Am Acad Dermatol
- D. Long et al.Interstitial granulomatous dermatitis with arthritisSee AlsoTREMFYA® (guselkumab) Approved by U.S. Food and Drug Administration as the First Selective Interleukin (IL)-23 Inhibitor for Active Psoriatic ArthritisMalay - Amboseli National Parks - Manyeleti Game Reserve (2022)5 Top and Strongest Marijuana Strains of 2022
J Am Acad Dermatol
- L. Verneuil et al.Interstitial granulomatous dermatitis with cutaneous cords and arthritisa disorder associated with autoantibodies
J Am Acad Dermatol
- C. Tomasini et al.Interstitial granulomatous dermatitis with plaques
J Am Acad Dermatol
- O.P. Sangueza et al.Palisaded neutrophilic granulomatous dermatitis in rheumatoid arthritis
J Am Acad Dermatol
- J.L. Jorizzo et al.Dermatologic conditions reported in patients with rheumatoid arthritis
J Am Acad Dermatol
There are more references available in the full text version of this article.
- Palisaded neutrophilic granulomatous dermatitis: Spectrum of histologic findings in a single patient
2017, JAAD Case Reports
Clinically, PNGD presents with tender, erythematous-to-violaceous papules, plaques, or nodules affecting the extensor surfaces. Acral, including palmar, involvement is characteristic, and umbilicated papules overlying bony prominences are also described.1,2,5 Histologically, early lesions of PNGD present with neutrophilic infiltrates and leukocytoclastic vasculitis; fully developed lesions feature palisaded granulomas with collagen trapping and neutrophil remnants.1
- Reactive Granulomatous Dermatitis: A Review of Palisaded Neutrophilic and Granulomatous Dermatitis, Interstitial Granulomatous Dermatitis, Interstitial Granulomatous Drug Reaction, and a Proposed Reclassification
2015, Dermatologic Clinics
As detailed, there exists substantial overlap between PNGD, IGD, and IGDR. The terms are at times used interchangeably in the literature,1,23 and some authors view drug-induced IGD and IGDR as the same entity with authors viewing IGD as a subset of PNGD, whereas other authors draw strict distinctions. The confusing nomenclature dates back to the earliest report, by Dykman and colleagues32 in 1965, who are credited with the first report of PNGD while describing patients with rheumatoid arthritis with linear subcutaneous bands, although that report was later the basis for further reports by Ackerman in 1993,30 which led to the term Ackerman dermatitis, which is felt by many to represent what is currently known as IGD.1,11
- Emerging Adverse Cutaneous Drug Reactions
2012, Dermatologic Clinics
- Palisaded neutrophilic and granulomatous dermatitis associated with the initiation of etanercept in rheumatoid arthritis: A case report
2011, Dermatologica Sinica
Although TNF-α antagonists suppress only a specific area of the immune system and are considered safe and well tolerated, various adverse cutaneous reactions have been confronted. In addition to the formation of leukocytoclastic vasculitis, urticaria, lichenoid drug eruptions and lupus erythematosus-like eruptions reported during TNF-α antagonist therapy,1 it has been suggested that anti-TNF-α therapy is associated with the onset of PNGD.2,3 It is well known that RA is the most common disease associated with PNGD; however, the correlation between the use of TNF-α antagonists and the development of PNGD in patients with RA remains controversial.
Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an unusual entity with variable clinical manifestations and histopathological features. It is associated with a variety of immune-mediated systemic diseases, most commonly in rheumatoid arthritis. We report a 42-year-old female with a long-standing history of rheumatoid arthritis, presenting with multiple pruritic erythematous papules and nodules on the lower legs 1 month after beginning treatment with etanercept. Microscopic examination of a fully developed lesion showed a diffuse dense interstitial lymphohistiocytic infiltrate interspersed with palisaded granulomas consisting of epithelioid histiocytes and multinucleated giant cells surrounding central zones of degenerated collagen, neutrophils and leukocytoclastic debris. A diagnosis of PNGD was made on the basis of typical histopathologic features. Withdrawal of etanercept led to gradual resolution of the skin lesions, with no new skin lesions appearing afterwards. Although the correlation between the use of tumor necrosis factor-α (TNF-α) antagonists and the development of PNGD remains controversial and warrants further investigation, PNGD should be considered in the differential diagnosis of skin eruptions within a setting of anti-TNF-α therapy.
- Granulomatous diseases: Kids are not just little people
2017, Clinics in Dermatology
Both IGD and PNGD can have either spontaneous resolution or clearance after treatment of the underlying condition. Several treatments have been reported to result in variable improvement; these include oral or topical steroids, dapsone, and colchicine.82,90 Xanthogranulomatous inflammation is characterized histologically by the presence of foamy histiocytes, Touton giant cells, lymphocytes, and varying degrees of necrosis or necrobiosis and fibrosis.91,92(Video) DERMATOPATHOLOGY: Granulomatous Dermatitis
Granulomatous diseases represent a heterogeneous group of conditions characterized by histiocytic inflammation that affect patients of any age. These diseases differ widely in their pathogenesis and include infectious and noninfectious conditions. This review focuses on noninfectious granulomatous conditions, with particular emphasis on age-related differences in the onset, epidemiology, clinical manifestations, prognosis, and age-specific management of specific granulomatous disorders. Knowledge of age-specific aspects of granulomatous conditions in adults and children improves both the extent of the diagnostic workup and the management of these patients.
The classification and clinical advance of reactive granulomatous dermatitis
2021, China Journal of Leprosy and Skin Diseases
Research articleExpert opinion on chemotherapy use in castration-resistant prostate cancer progressing after docetaxel
Critical Reviews in Oncology/Hematology, Volume 88, Issue 2, 2013, pp. 357-367
The term castration-resistant prostate cancer (CRPC) encompasses a wide variety of patients with different prognoses. The combination of docetaxel and prednisone is considered as the standard first-line chemotherapy. For years, patients progressing on docetaxel have been managed with second- and third-line hormone therapies, re-treatment with docetaxel, or combined mitoxantrone and prednisone. Recently published results of four studies using different drugs: cabazitaxel (CBZ), abiraterone (AA), enzalutamide (ENZ), and radium 223, showed an increased survival in such patients. In this article, authors make some considerations about criteria guiding the choice of a second-line chemotherapy after docetaxel in patients with metastatic CRPC, and propose an algorithm based on scientific evidence and consensus for rational use of cabazitaxel in this scenario.
Research articleT2-weighted imaging of the heart—A pictorial review
European Journal of Radiology, Volume 82, Issue 10, 2013, pp. 1755-1762
Spin-Echo techniques in cardiovascular magnetic resonance (CMR) have been used for decades, primarily to image cardiac anatomy. More recently, T2-weighted (T2W) imaging has seen an increased role in CMR protocols, especially in tissue characterization in acute myocardial processes. This article will review current methodologies of cardiac T2W acquisition and their limitations, as well as approach to both semi-quantitative and quantitative analyses. The appearance and utility of T2W imaging in a myriad of pathologic myocardial processes such as acute myocardial infarction, acute viral myocarditis, reversible stress-related cardiomyopathy, hypertrophic cardiomyopathy, and cardiac sarcoidosis, will also be discussed.
Research articleThe Significance of the Discordant Occurrence of Lens Tumors in Humans versus Other Species
Ophthalmology, Volume 122, Issue 9, 2015, pp. 1765-1770
The purpose of this study was to determine in which species and under what conditions lens tumors occur.
A review of databases of available human and veterinary ocular pathologic material and the previously reported literature.
Approximately 18 000 patients who had ocular surgical specimens submitted and studied at the University of Wisconsin School of Medicine and Public Health between 1920 and 2014 and 45 000 ocular veterinary cases from the Comparative Ocular Pathology Laboratory of Wisconsin between 1983 and2014.
Material in 2 major archived collections at the University of Wisconsin medical and veterinary schools were studied for occurrence of lens tumors. Tumor was defined as a new growth of tissue characterized by progressive, uncontrolled proliferation of cells. In addition, cases presented at 3 major eye pathologic societies (Verhoeff-Zimmerman Ophthalmic Pathology Society, Eastern Ophthalmic Pathology Society, and The Armed Forces Institute of Pathology Ophthalmic Alumni Society) from 1975 through 2014 were reviewed. Finally, a careful search of the literature was carried out. Approval from the institutional review board to carry out this study was obtained.
The presence of tumors of the lens.
The database search and literature review failed to find an example of a lens tumor in humans. In contrast, examples of naturally occurring lens tumors were found in cats, dogs, rabbits, and birds. In the veterinary school database, 4.5% of feline intraocular and adnexal neoplasms (234/5153) were designated as feline ocular posttraumatic sarcoma, a tumor previously demonstrated to be of lens epithelial origin. Similar tumors were seen in rabbit eyes, a bird, and in a dog. All 4 species with lens tumors had a history of either ocular trauma or protracted uveitis. The literature search also revealed cases where lens tumors were induced in zebrafish, rainbow trout, hamsters, and mice by carcinogenic agents (methylcholanthrene, thioacetamide), oncogenic viruses (SV40, HPV-16), and genetic manipulation.
Our results suggest that lens tumors do not occur in humans. In contrast, after lens capsule rupture, a lens tumor can occur in other species. We hypothesize that a genetic mechanism exists that prevents lens tumors in humans.(Video) Granulomatous Skin Diseases 101: Dermpath Basics for Dermatology Pathology & USMLE
Research articleLocalized Amyloid Light-Chain Amyloidosis and Extramedullary Plasmacytoma of the Mitral Valve
The Annals of Thoracic Surgery, Volume 95, Issue 5, 2013, pp. 1782-1784
An unusual case of localized amyloid light-chain (AL) amyloidosis and extramedullary plasmacytoma of the mitral valve is described. The worsening of a mitral regurgitation led to investigations and surgery. The valve presented marked distortion and thickening by type AL amyloid associated with a monotypic CD138+ immunoglobulin lambda plasma cell proliferation. Systemic staging showed a normal bone marrow and no evidence of amyloid deposition in other localizations. The patient's outcome after mitral valve replacement was excellent. To our knowledge, this is the first description of a localized AL amyloidosis as well as of a primary extramedullary plasmacytoma of the mitral valve.
Research articleUsing sewage sludge pyrolytic gas to modify titanium alloy to obtain high-performance anodes in bio-electrochemical systems
Journal of Power Sources, Volume 372, 2017, pp. 38-45
Titanium is under consideration as a potential stable bio-anode because of its high conductivity, suitable mechanical properties, and electrochemical inertness in the operating potential window of bio-electrochemical systems; however, its application is limited by its poor electron-transfer capacity with electroactive bacteria and weak ability to form biofilms on its hydrophobic surface. This study reports an effective and low-cost way to convert a hydrophobic titanium alloy surface into a hydrophilic surface that can be used as a bio-electrode with higher electron-transfer rates. Pyrolytic gas of sewage sludge is used to modify the titanium alloy. The current generation, anodic biofilm formation surface, and hydrophobicity are systematically investigated by comparing bare electrodes with three modified electrodes. Maximum current density (15.80 A/m2), achieved using a modified electrode, is 316-fold higher than that of the bare titanium alloy electrode (0.05 A/m2) and that achieved by titanium alloy electrodes modified by other methods (12.70 A/m2). The pyrolytic gas-modified titanium alloy electrode can be used as a high-performance and scalable bio-anode for bio-electrochemical systems because of its high electron-transfer rates, hydrophilic nature, and ability to achieve high current density.
Research articleTemporal changes in neutral endopeptidase/CD10 immunoexpression in the cyclic and early pregnant canine endometrium
Theriogenology, Volume 82, Issue 6, 2014, pp. 815-826
CD10 is a multifunctional transmembrane neutral endopeptidase (NEP) that is considered to be a reliable marker of ectopic human endometrial stroma. Available information on NEP/CD10 protein expression in animal endometria is scarce. This study focused on the immunolocalization of NEP/CD10 in the canine uterus and on its temporal changes during the estrous cycle and early pregnancy (Days 11 to 23 post-LH surge) in healthy females. NEP/CD10 expression was found in the canine endometrial stroma in all stages of the estrous cycle, showing cyclic differences both in intensity and in distribution pattern. A small population of negative stromal cells in subsurface position was also observed. This population shared some morphological characteristics with the human predecidual cells, which became positive in progesterone-associated stages of the cycle. In addition, positive immunolabeling was also observed in canine myometrial stroma. In early pregnancy, the basal glandular epithelia and the syncytium cords remained negative to this marker contrasting with the trophoblast and the lacunar epithelium. A weak to moderate intensity of immunolabeling was observed in the decidual cells, whereas stromal immunolabeling was more intense at the delimitation of the syncytium cords. In conclusion, CD10 is consistently expressed in the canine endometrial stroma and myometrium but not in the endometrial epithelia. The characteristic pattern seen in early pregnancy also suggests a role for this molecule in the process of embryo invasion at implantation.
Copyright © 2004 Elsevier Inc. All rights reserved.
Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an inflammatory cutaneous disorder of unknown etiology that usually manifests as skin-colored to erythematous papules or plaques on the extremities (picture 1A-B). PNGD typically occurs in association with systemic disease.
Background. Interstitial granulomatous dermatitis (IGD) is a rare disease that clinically presents with a pruritic and painful rash revealing symmetric, erythematous, and violaceous plaques over the lateral trunk, buttocks, and thighs . Fewer than 70 cases have been documented in the literature .
Palisading granuloma (known also as necrotizing granuloma) is a histological variety of a granuloma, characterized by the presence of macrophages and giant cells arranged in a tier-like fashion on the border of collagen degeneration (necrobiosis) [4, 5].
Corticosteroid injections. If the skin lesions aren't clearing up with topical treatment, your doctor may suggest a corticosteroid injection. Repeat injections may be needed every 6 to 8 weeks until the condition clears up.
Granulomatous periorificial dermatitis (GPD), also known as childhood granulomatous periorificial dermatitis (CGPD), is an uncommon, benign inflammatory skin disease that affects primarily dark-skinned prepubertal children; few cases have been reported in adults.
Aim. Both interstitial granulomatous dermatitis (IGD) and palisaded neutrophilic granulomatous dermatitis (PNGD) are rare disorders typically associated with systemic autoimmune conditions.
Granuloma annulare is occasionally associated with diabetes or thyroid disease, most often when lesions are numerous or widespread. It may, rarely, be related to cancer, especially in older people whose granuloma annulare is severe, doesn't respond to treatment or returns after cancer treatment.
Other drugs that have been reliably reported to cause granulomatous hepatitis include quinidine, phenytoin (usually with vasculitis), sulfonamides (usually with vasculitis), nitrofurantoin, aspirin, papaverine, procainamide, sulfasalazine, mesalamine, and glyburide.
A granuloma is a small area of inflammation. Granulomas are often found incidentally on an X-ray or other imaging test done for a different reason. Typically, granulomas are noncancerous (benign). Granulomas frequently occur in the lungs, but can occur in other parts of the body and head as well.
An eosinophilic granuloma is a benign bone tumor. It's the mildest form of Langerhans cell histiocytosis, a rare disease that causes your body to produce too many immune cells. Eosinophilic granulomas usually affect kids under 10. The growths are always benign. This means they're not a symptom — or cause — of cancer.
A collagenolytic or necrobiotic non-infectious granuloma is one in which a granulomatous infiltrate develops around a central area of altered collagen and elastic fibers. The altered fibers lose their distinct boundaries and exhibit new staining patterns, becoming either more basophilic or eosinophilic.
Granulomatous inflammation is caused by a variety of conditions including infection, autoimmune, toxic, allergic, drug, and neoplastic conditions. The tissue reaction pattern narrows the pathologic and clinical differential diagnosis and subsequent clinical management.
What does that mean? A granuloma is a small area of inflammation. Granulomas are often found incidentally on an X-ray or other imaging test done for a different reason. Typically, granulomas are noncancerous (benign). Granulomas frequently occur in the lungs, but can occur in other parts of the body and head as well.
Chronic granulomatous disease (CGD) is a genetic disorder in which white blood cells called phagocytes are unable to kill certain types of bacteria and fungi. People with CGD are highly susceptible to frequent and sometimes life-threatening bacterial and fungal infections.
The most familiar atypical mycobacterial infection which reveals suppurative granuloma histopathologically is swimming pool granuloma or fish tank granuloma. It is caused by Mycobacterium marinum which is the most common variant of atypical mycobacterial infection affecting human.