Cutaneous extravascular necrotizing granuloma and lymphocytic lymphoma

A patient had clinical findings of asthma, peripheral eosinophilia, multisystem abnormalities, and cutaneous extravascular granulomas, consistent with a diagnosis of allergic granulomatosis. In addition, a well-differentiated lymphocytic lymphoma was diagnosed on the basis of bone marrow findings, and a monoclonal gammopathy was demonstrated by serum immunoelectrophoresis. Clinically, the skin lesions appeared as erythematous papules or nodules on the extremities, and some of them showed central ulceration. Histologically, there were dermal extravascular necrotizing granulomas embedded in a granulomatous and inflammatory cell infiltrate. These lesions bore a striking resemblance to those described by Churg and Strauss in patients with allergic granulomatosis, although tissue eosinophilia was significantly less prominent.