Generalized granuloma annulare in an infant clinically manifested as papules and atrophic macules:A case report

BACKGROUND Granuloma annulare(GA)has diverse clinical manifestations including papules,plaques,and nodules on the extremities that are skin-colored,pink,or purple.Approximately 15%of all GA cases are considered generalized GA.CASE SUMMARY Herein,we describe the case of a pediatric patient who initially presented with papules and later developed generalized atrophic macules.Upon examination,two different morphologic lesions were histopathologically confirmed:Epithelioid nodular GA and scattered histiocytic infiltrative GA.This patient exhibited rare clinical manifestations that differed throughout the course of the disease.The varying histopathological types and clinical manifestations of GA may be linked to the different stages of the disease.CONCLUSION This rare case demonstrates the different histopathological features of different stages and clinical manifestations of granuloma annulare in an infant.

Elastic fiber degradation in the development of pediatric granuloma annulare:Report of 39 cases

BACKGROUND Granuloma annulare(GA)has diverse clinical manifestations,multiple subtypes,and unknown etiology and pathogenesis.Existing studies regarding GA in children are scarce.AIM To examine the correlation between clinical manifestation and histopathology of pediatric GA.METHODS A total of 39 patients under 18 years of age with both a clinical and pathological diagnosis of GA at Kunming Children's Hospital from 2017 to 2022 were retrieved.Their medical records were consulted,and clinical data of the children were recorded and summarized,including gender,age,disease site,etc.Existing wax blocks of skin lesion specimens of children and pathological films were retrieved for further study and relevant histology,including hematoxylin-eosin,Alcian blue,elastic fiber(Victoria blue-Lichon red method),and antacid staining.Finally,the children’s clinical manifestations,histopathological results,and special staining characteristics were analyzed.RESULTS The clinical manifestations of granuloma annulare in children were diverse:11 cases presented with a single lesion,25 with multiple lesions,and 3 with generalized lesions.The pathological typing comprised histiocytic infiltration,palisading granuloma,epithelioid nodular,and mixed types in 4,11,9,and 15 cases,respectively.Thirty-nine cases were negative for antacid staining.The positive rate of Alcian blue staining was 92.3%,and that of elastic fiber staining was 100%.The degree of elastic fiber dissolution and granuloma annulare histopathological typing were positively correlated(r=0.432,P<0.05).No correlation was found between clinical presentation and histopathological typing of the granuloma annulare in children.In the pathological diagnosis of granuloma annulare,the positive elastic fiber staining rate was higher than that of Alcian blue staining.A correlation was found between elastic fiber dissolution degree and histopathological staging.However,the differences in pathological staging may have been related to the pathological manifestation of granuloma annulare at different periods.CONCLUSION Elastic fiber degradation may be a critical step in the pathogenesis of pediatric granuloma annulare.This is also one of the first studies focused on granuloma annulare in children.

Annulare With Tuberculosis and Cutis Laxa: A Rare Case Report

Introduction:Granuloma annulare(GA)is a benign,noninfectious granulomatous disorder of unknown etiology,characterized by an annular arrangement of erythematous small nodules and plaques,classically localized on dorsal surfaces of the hands and feet.GA shows palisading granulomas with a central zone of necrobiotic collagen and mucin deposition surrounded by a palisade of histiocytes.Here,we reported a 24-year-old man with GA combined with tuberculosis and cutis laxa.Case presentation:A 24-year-old man was presented with skin annular lesions on the trunk and extremities without subjective symptoms for three years.The annular lesions first arose in the trunk that slowly progressed to most parts of the body and cutis laxa-like lesions appeared on the left inguinal region with inguinal hernia two years ago.At the same time,the patient was diagnosed with pulmonary tuberculosis due to the hemoptysis for two years and the sputum culture for tuberculosis bacillus was positive.He was treated with triple anti-tuberculosis drugs regularly.Partial remission of the skin lesions was noted since then.Pathological examination showed similar histological changes in the interstitial pattern of GA.Discussion:Tuberculosis was a possible etiologic factor in GA because of the coincidental occurrence,granulomatous histologic features,and positive tuberculin skin tests.In fact,some cases of GA with chronic pulmonary tuberculosis responding to a specific anti-tuberculosis therapy were reported.It is worth noting that tuberculids,generalized exanthems in the skin of tuberculous patients possibly resulting from hypersensitivity reactions to the tubercle bacillus,may mimic GA.Furthermore,our patient also showed extremely characteristic slack skin in posterior lumbar and groin,which was deemed to be related to reduction and destruction of elastic fibers.Conclusion:Generalized interstitial GA with tuberculosis and cutis laxa is vary rare,which is worth being aware of the possibility of such a occurrence.