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Subcutaneous Granuloma Annulare.

Tatiana Ţăranu, Mirela Grigorovici, Magda Constantin

  • 1Mihaela Paula Toader MD, PhD, T. Popa University of Medicine and Pharmacy, Iasi, Romania, 16 Universitatii str. 700115, Iasi, Romania; toaderpaula@gmail.com.

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Summary

Subcutaneous granuloma annulare (SGA) is a rare variant of granuloma annulare presenting as subcutaneous nodules. Diagnosis involves clinical evaluation and skin biopsy, with low risk of systemic involvement.

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Area of Science:

  • Dermatology
  • Rheumatology
  • Pathology

Background:

  • Subcutaneous granuloma annulare (SGA) is a rare clinical variant of granuloma annulare, a common chronic inflammatory disorder.
  • It typically affects children and young adults, presenting as subcutaneous nodules, often misdiagnosed initially.

Observation:

  • A case of a 29-year-old female with a 13-year history of subcutaneous nodules on fingers and toes, initially diagnosed as sero-negative rheumatoid arthritis.
  • Clinical examination revealed asymptomatic, pigmented subcutaneous nodules. Laboratory and imaging tests were normal, ruling out rheumatoid arthritis.
  • Pathological examination of a nodule showed collagen changes with inflammatory cells, consistent with pseudorheumatoid nodules.

Findings:

  • SGA is a rare variant of granuloma annulare, predominantly affecting younger individuals, but also reported in adults.
  • Diagnosis relies on clinical presentation, patient history, and histopathological examination, differentiating it from rheumatoid nodules.
  • While generally benign with a low risk of systemic involvement, recurrences are common, and periodic follow-up is recommended.

Implications:

  • This case highlights the importance of considering SGA in the differential diagnosis of subcutaneous nodules, especially when rheumatoid arthritis markers are negative.
  • Accurate diagnosis through skin biopsy is crucial for appropriate management and to avoid unnecessary treatments.
  • Understanding SGA's clinical behavior and potential for recurrence is essential for patient management and prognosis.