VCOM Louisiana Research Day Program

Clinical & Case Studies

1 Raj H. Patel, MBA, OMS-III; 2 Padma V. Chitnavis, MD; 2,3 Douglas J. Grider, MD 1 Edward Via College of Osteopathic Medicine, Monroe, Louisiana; 2 Dermatology and Mohs Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; 3 Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia 25 SUBCUTANEOUS GRANULOMA ANNULARE IN AN ADULT

Context/Impact: Subcutaneous granuloma annulare is a rare and benign variant of granuloma annulare, typically seen in children, which presents as asymptomatic subcutaneous nodules with normal overlying skin. The pathogenesis remains unclear despite associations with systemic disease. Clinical diagnosis is challenging as the appearance of this entity closely resembles that of rheumatoid nodules, thus histopathologic evaluation is necessary for accurate diagnosis and treatment. Report of Case: We present a 53-year-old female who presented with multiple painful nodules present bilaterally on her elbows. Her history was notable for hypothyroidism, diabetes mellitus, and chronic gout. Skin examination revealed bilateral, tender, dermal nodules, and plaques on the elbows. Punch biopsy of the right elbow revealed palisading granulomas surrounding central necrobiotic material and mucin deposits. She presented one month later with significant improvement of the lesions without treatment. Six months later, the lesions recurred, and she was treated with intralesional injection of triamcinolone on the bilateral elbows. Comments/Conclusion: Our case demonstrates the importance of a thorough workup in patients presenting with tender,

subcutaneous nodules without a history of rheumatoid arthritis or other predisposing conditions. Subcutaneous granuloma annulare typically presents in children and have been termed as ‘pseudorheumatoid nodules’ due to the close resemblance to rheumatoid nodules. Our case emphasizes the importance of differentiating this entity from using both clinical and histopathologic evaluation to avoid unnecessary treatment for a benign, self resolving disease.

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