Granuloma Multiforme: A Rare Granulomatous Disease

Area of Science:

• Dermatology
• Pathology

Background:

• Granuloma Multiforme (GM) is a rare reactive skin disorder characterized by annular lesions and necrobiosis.
• Historically, GM has been predominantly reported in Africa, particularly in regions with endemic leprosy.
• Its occurrence outside Africa is infrequent, with limited cases documented globally.

Observation:

• A 59-year-old female farmer presented with a year-long history of mildly pruritic, annular and polycyclic plaques with raised, beaded borders.
• The lesions were distributed across her upper trunk, lower back, and arms.
• Histopathological examination revealed focal loss of elastic fibers in the upper dermis and histiocytes engulfing elastic fibers.

Findings:

• This case represents the second reported instance of Granuloma Multiforme in Nepal.
• The histopathological findings are consistent with GM, including the characteristic necrobiosis and altered elastic fibers.
• The clinical presentation, while distinct, shares similarities with granuloma annulare, posing a diagnostic challenge.

Implications:

• This report expands the geographical understanding of Granuloma Multiforme, particularly its presence in Asia.
• It underscores the importance of considering GM in differential diagnoses, especially in leprosy-endemic areas.
• In resource-limited settings relying on clinical diagnosis, careful evaluation is crucial to distinguish GM from granuloma annulare and ensure appropriate management.