Generalized annular granuloma after initiation of therapy with beta

blockers for glaucoma-case report-

• * Dermatology Department, „Carol Davila” Central University Emergency Military Hospital, Bucharest

• ** Dermatopathology Department, „Domina-Sana” Medical Center, Bucharest

Andreea Stancu* , Aurel Doru Chirita**, Irina Margaritescu**

Introduction• Granuloma annulare (GA) is a benign

inflammatory dermatosis• Granuloma annulare is a relatively common

disease that occurs in all age groups• Characterized:– clinically by dermal papules and annular

plaques –histologically by foci of degenerative collagen

associated with palisaded granulomatous inflammation

Clinical case We report a case of a

59 years-old women who presented with a 3 months history of pruritic papules, patches and well circumscribed plaques

The lesions appeared first on the abdomen and anterior thorax and in a few days they became generalized

Clinical case

Disseminated erythematous papules, patches, plaques

Granulomatous nodular dermatitis with superficial and deep perivascular infiltrate of lymphocytes and histiocytes arranged in a palisade around a locus that consists mostly of mucin, and degenerated collagen bundlles

Histiocytes in a palisade and scattered interstitiallyDegeneration of collagenDeposits of mucin

Interstitial lymphocytes and epithelioid histiocytes

Discussion

• Granuloma annulare can present with two different histologic patterns:

PalisadedInterstitialOur case have findings of both palisaded and

interstitial patterns

Conclusions• Although the aetiology and pathogenesis of

granuloma annulare are unclear, it appears likely that it represents a reaction pattern to a variety of triggering factors

• Because lesions started after the initiation of the B-blocker treatment we suspected a drug reaction

• Treatment:– discontinuation of culprit drug– Corticosteroids– PUVA-therapy