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Pathology of Interstitial Granulomatous Dermatitis

Dr Sampurna Roy MD           

Dermatopathology Quiz Case 212 

Diagnosis: Interstitial Granulomatous Dermatitis





Synonyms: Interstitial granulomatous dermatitis with cutaneous cords and arthritis ; Rheumatoid papules ; Palisaded and neutrophilic granulomatous dermatitis.

Interstitial granulomatous dermatitis is a rare systemic disorder which is usually associated with systemic auto-immune conditions or malignant lymphoproliferation.

Clinically, it may be present as linear (the 'rope sign') or arciform subcutaneous cords, papules or plaques.

Microscopic features:

Different patterns have been described:

(i) May resemble incomplete granuloma annulare, with an interstitial and perivascular dermal infiltrate of neutrophils, histiocytes, lymphocytes and sometimes eosinophils.

Dermal collagen appears basophilic.

(ii) There may be small granulomas composed of palisade of histiocytes around basophilic collagen fibers.

Some neutrophils may be present.

The changes are usually prominent in the lower half of the dermis.

Clue to diagnosis of interstitial granulomatous dermatitis with arthritis:

A granuloma annulare-like dermatitis with neutrophils and eosinophils usually present in the lower two thirds of the dermis.


Further reading

Interstitial granulomatous dermatitis in a patient with lupus erythematosus.

Interstitial granulomatous dermatitis: a distinct entity with characteristic histological and clinical pattern.

Exacerbation of interstitial granulomatous dermatitis with arthritis by anakinra in a patient with diffuse large B-cell lymphoma.

Palisaded neutrophilic and granulomatous dermatitis associated with ankylosing spondylitis.

Interstitial granulomatous dermatitis and arthritis revealing oesophageal carcinoma.

A child with interstitial granulomatous dermatitis and juvenile idiopathic arthritis.

A palpable erythematous cord over the trunk in a patient with systemic lupus erythematosus. Interstitial granulomatous dermatitis (IGD).

Generalized erythematous-violaceous plaques in a patient with a history of dyslipidemia. Interstitial granulomatous drug reaction (IGDR).

Interstitial granulomatous drug reaction to a Chinese herb extract.

Interstitial granulomatous dermatitis with arthritis responding to tocilizumab.

Interstitial granulomatous dermatitis (Ackerman's Syndrome).




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)







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