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Infiltration of the dermis by lymphocytes and histiocytes, without deposition of mucin (HE ×10).
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Figure 2: Infiltration of the dermis by lymphocytes and histiocytes, without deposition of mucin (HE ×10).

Mentions: Biopsy of a papule showed a normal epidermis and a perivascular and diffuse infiltration of the dermis by lymphocytes, histiocytes and a few giant cells, without deposition of mucin (fig. 2, fig. 3, fig. 4). Chest X-ray examination, tuberculin skin (PPD) test as well as QuantiFERON-TB test were all negative. ACE levels were within normal limits.

Interstitial Granulomatous Dermatitis: Another Clinical Variant

Patsatsi A, Kyriakou A, Triantafyllidou E, Sotiriadis D - Case Rep Dermatol (2011)

Bottom Line: The lesions cleared only after re-initiation of treatment 2 months later.Interstitial granulomatous dermatitis is thought to be a distinct histopathological pattern, either drug induced or associated with rheumatoid arthritis or autoimmune collagen diseases.In our case, there was a distinct clinical presentation of interstitial granulomatous dermatitis, composed of symmetrically distributed indurated papules around the umbilicus as well as a mild granulomatous reaction pattern.

Affiliation: 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece.

ABSTRACT
A 70-year-old female patient presented with an eruption consisting of symmetrically distributed erythematous papules around the umbilicus 1 month after the cessation of adalimumab for the treatment of rheumatoid arthritis. Biopsy of a papule showed an interstitial granulomatous infiltrate in the dermis, without deposition of mucin. The lesions cleared only after re-initiation of treatment 2 months later. Interstitial granulomatous dermatitis is thought to be a distinct histopathological pattern, either drug induced or associated with rheumatoid arthritis or autoimmune collagen diseases. In our case, there was a distinct clinical presentation of interstitial granulomatous dermatitis, composed of symmetrically distributed indurated papules around the umbilicus as well as a mild granulomatous reaction pattern.

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