Granuloma Annularis Revealing Wegener's Granulomatosis

Abstract

Skin manifestations are often associated with systemic autoimmune diseases (SAD). Some SAD, such as systemic lupus erythematosus, psoriatic arthritis and scleroderma display pathognomonic dermatological features, whereas other systemic diseases such as sarcoidosis, vasculitis and rheumatoid arthritis can present with non-specific skin manifestations that range from erythema nodosum to necrotic lesions. Here we report the case of a 25-year-old man with uveitis, polyarthrirtis, pulmonary involvement, nephrotic syndrome, cutaneous granuloma and pneumonia by E. coli.Skin manifestations are often associated to systemic autoimmune diseases (SAD). Some SAD, such as systemic lupus erythematosus, psoriatic arthritis and scleroderma display dermatological features that are pathognomonic, whereas other systemic diseases such as sarcoidosis, vasculitis and rheumatoid arthritis can present with non-specific skin manifestations that range from erythema nodosum to necrotic lesions (l, 2). Differential diagnosis among granulomatous diseases can be difficult, since they can present with similar or overlapping clinical features, thus auto-antibodies, such as antineutrophil cytoplasm antibodies (ANCA) are often helpful to make a definitive diagnosis (3, 4). Here we report the case of a 25-year-old man with uveitis, polyarthrirtis, pulmonary involvement, nephrotic syndrome, cutaneous granuloma and pneumonia by Escherichia coli. Case reportA 25-year-old man was admitted to our Department because of fever (38.5°C), cough and malaise which had initiated three months previously and was resistant to antibiotic therapy. On physical examination, he showed symmetrical and additive polyarthritis localized to the large joints of the lower limbs and to the large and small joints of the upper limbs, conjuntival redness, later identified as anterior uveitis, and a pulmonary abolition of the murmur at the right lower lobe. Skin examination detected small reddish nodules on the right elbow, where the skin was dry and scaly (Fig. 1). Laboratory tests showed normochromic normocytic anemia (haemogobin: 11.2 g/dL), increased C reactive protein (C-RP

Reply

“…We would like to thank Dr. Park and colleagues for their interest in our article and for their description of 4 cases of lupus psychosis. Albeit rare in occurrence, psychosis has been reported as an early manifestation of SLE in several studies (1,2). In the SLICC cohort, the earliest psychotic episode occurred 2 months prior to the diagnosis of SLE, so it is incorrect that "almost one-fourth of psychotic events occurred a year prior to the diagnosis of lupus."…”

Facial Papular Lesions in Granulomatosis With Polyangiitis

“…In immunocompromised individuals presenting with granulomatous cutaneous lesions, mycobacterial or fungal infections should be ruled out. Other conditions seldomly coexisting with GPA, e.g., erythema elevatum diutinum (EED) , granuloma annularis , and Sweet syndrome , should be considered in the differential diagnosis. In EED, papules appear on extensor surfaces, and leukocytoclastic vasculitis is the key diagnostic histologic feature.…”