Bone Lesions, Lymphadenopathy, and Hepatic Granulomas in a Patient With Psoriasis

Vu, Khoan; Atkinson, John P.; Ranganathan, Prabha

doi:10.1002/acr.22607

Cited by 2 publications

(2 citation statements)

References 41 publications

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“…The presence of necrosis is rare and, if present, should warrant a detailed evaluation for infectious or other nonsarcoid processes . However, there have been cases of sarcoidosis with necrotizing granulomas reported in the literature . The presence of necrobiosis and Touton giant cells in our patient's biopsy sample made sarcoidosis an unlikely diagnosis.…”

Section: Differential Diagnosismentioning

confidence: 72%

A 55‐Year‐Old Man With Periorbital and Inguinal Masses, Pericarditis, and Pleuritis

Gupta

Frater

et al. 2017

Arthritis Care & Research

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A 55-year-old male was referred to the rheumatology clinic for evaluation of recurrent inguinal and periorbital masses. History of the present illnessA 55-year-old white man with ulcerative colitis in remission and coronary artery disease developed an indurated 5-cm right inguinal subcutaneous mass approximately 6 years prior to presentation. An excisional biopsy demonstrated lymphoid follicular hyperplasia. Three years later, the right inguinal mass reappeared. Repeat surgical excision revealed a xanthogranulomatous infiltrate with necrobiosis, cholesterol clefts, and Touton giant cells (large multinucleated cells with a ring of nuclei surrounded by foamy cytoplasm). Gomori methenamine silver and Fite stains were negative for fungal or mycobacterial organisms. Despite removal, the mass reappeared within 4 months and slowly but progressively increased in size, accompanied by hyperpigmentation and a yellow discoloration of the overlying skin. One year prior to presentation, he developed shortness of breath and was found to have pericarditis complicated by pericardial effusion and tamponade for which he underwent a pericardiocentesis and pericardial window. Cytology of the fluid was negative for malignant cells. A pericardial biopsy demonstrated a thickened pericardial wall with florid chronic inflammation, fibrosis, and numerous plasma cells. In situ hybridization studies showed a kappa restricted monoclonal plasma cell population. Around that time, he also developed a tight band-like mass at the base of his penis. The right inguinal mass continued to increase in size, and ulceration of the overlying skin developed. Nine months prior to presentation, he noted a left periorbital 1-cm mass that increased in size, leading to ptosis and decreased peripheral vision. He also developed a right periorbital mass that was smaller in size. Computed tomography (CT) of the orbits showed bilateral lacrimal gland enlargement. Biopsy findings of the left periorbital mass showed a lymphoplasmacytic infiltrate with intervening areas of fibrosis, focal areas of necrobiosis, and Touton giant cells. Flow cytometry of this tissue showed a polyclonal B cell population. Two months prior to presentation, he developed shortness of breath and fatigue, and a chest radiograph demonstrated bilateral pleural effusions. The pleural fluid had a pH of 7.29. There were 164,000 red blood cells and 1,952 nucleated cells with a differential of 29% neutrophils, 52% lymphocytes, 7% monocytes, and 12% eosinophils. The glucose was less than 20 mg/dl. The protein was 5.7 gm/dl, and lactate dehydrogenase was 2,474 units/liter. Cultures and cytology findings were negative. Around the same time, he developed an erythematous, maculopapular rash on the lower extremities that resolved spontaneously in a week. He presented 2 months later to the rheumatology clinic for further evaluation. Past medical history and medicationsHe had a history of ulcerative colitis diagnosed at age 27 years, which was in remission on mesalamine, hyperlipidemia (lipid profile at age 5...

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Section: Differential Diagnosismentioning

confidence: 72%

A 55‐Year‐Old Man With Periorbital and Inguinal Masses, Pericarditis, and Pleuritis

Gupta

Frater

et al. 2017

Arthritis Care & Research

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“…It rarely affects also the liver; hepatic sarcoidosis may present as asymptomatic hepatic granulomas to clinically evident disease with cholestasis or, in advanced cases, cirrhosis and portal hypertension. Occasionally HS may occur together with other inflammatory diseases, namely, psoriasis [ 127 – 130 ].…”

Section: Hepatic Sarcoidosis (Hs)mentioning

confidence: 99%

Liver Illness and Psoriatic Patients

Fiore

Leone

Maraolo

et al. 2018

BioMed Research International

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Psoriasis is a chronic inflammatory disease of the skin affecting approximately 2% of the world's population. Systemic treatments, including methotrexate and cyclosporin, are associated with potential hepatotoxicity, due to either direct liver damage or immunosuppression or both immunomediated and a direct liver injury; therefore, treatment of patients with psoriasis poses a therapeutic challenge. The aim of this minireview is to help clinicians in the management of psoriatic patients who develop signs of liver dysfunction. To find relevant articles, a comprehensive search was performed on PubMed, EMBASE, and Cochrane with appropriate combinations of the following keywords being considered: viral hepatitis, nonalcoholic fatty liver disease, psoriasis, hepatotoxicity, drug toxicity, cholestasis, and autoimmune liver diseases.

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Bone Lesions, Lymphadenopathy, and Hepatic Granulomas in a Patient With Psoriasis

Abstract: A 49-year-old man with longstanding plaque psoriasis presented with subjective fevers, dry cough, shortness of breath, and weight loss for 5 weeks.

Cited by 2 publications

References 41 publications

A 55‐Year‐Old Man With Periorbital and Inguinal Masses, Pericarditis, and Pleuritis

A 55‐Year‐Old Man With Periorbital and Inguinal Masses, Pericarditis, and Pleuritis

Liver Illness and Psoriatic Patients

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