both interstitial granulomatous dermatitis ( igd ) and palisaded neutrophilic granulomatous dermatitis ( pngd ) are rare disorders typically associated with systemic autoimmune conditions .
they probably represent different aspects of a disease spectrum encompassing the concept of autoimmunity - related granulomatous dermatitis ( argd ) .
the present case shows that the clinicopathological correlation in argd does not always clearly fit with the classical presentations of igd or pngd .
a number of autoimmune conditions are associated with cutaneous symptoms . interstitial granulomatous dermatitis ( igd )
the typical clinical presentation corresponds to a linear rope present on the trunk and axillae . on histopathological examination ,
igd is characterized by a sparse palisaded histiocytic infiltrate with little neutrophilic debris and eosinophils associated with a necrobiotic aspect of the collagen matrix . in the literature
, there is some overlap between igd and palisaded neutrophilic granulomatous dermatitis ( pngd ) .
lesions of pngd typically correspond to papules occasionally admixed with small crusts on the elbows .
other related disorders include rheumatoid papules , churg - strauss granuloma , superficial ulcerating rheumatoid necrobiosis , necrobiotic granuloma , palisading granuloma , cutaneous extravascular necrotizing granuloma , and rheumatoid neutrophilic dermatitis . here ,
a 61-year - old woman presented with skin lesions over the elbows and the left thenar region .
they corresponded to erythematous and discrete hyperkeratotic papules which had been present for a few weeks ( fig .
immunohistochemistry revealed the presence of cd3 + t lymphocytes predominating in the perivascular area ( fig .
they were associated with cd68 + and mac387 + histiocytes as well as factor xiiia+ dermal dendrocytes ( dd1 ) .
the pattern of dd1 distribution was similar to that of cd68 + histiocytes ( fig .
it was characterized by the elevation of anti - smooth muscle antibodies ( 1:160 ) and antinuclear antibodies ( 1:1,280 ) .
there were no detectable antibodies directed against nuclear antigens , keyhole limpet hemocyanin and mitochondria .
hepatitis b and c serologies were negative . at the time of presentation , the patient 's liver tests were in the normal range .
however , they recurred a few months later , and some other lesions appeared on the thighs .
in some cases , there is a mismatch between the clinical presentation and the histopathological patterns of igd and pngd .
indeed , these two conditions possibly represent a continuum or progression of a single disease process corresponding to autoimmunity - related granulomatous dermatitis ( argd ) [ 6 , 8 ] .
the clinical associations between argd , autoimmune disease and lymphoproliferative disorders have been intermixed between both igd and pngd diagnoses in the literature [ 6 , 9 , 10 , 11 , 12 , 13 , 14 ] .
it is acknowledged that the inflammatory cell infiltrate is sparse to moderate in igd , while pngd has a dense neutrophilic and interstitial histiocytic infiltrate .
only a single case of igd with autoimmune hepatitis   association has been reported so far .
some other autoimmune comorbidities including arthritis , antiphospholipid syndrome [ 18 , 19 ] and hematologic malignancy   have been reported in association with igd .
in addition , interstitial granulomatous drug reactions have been linked to tnf inhibitors , ace inhibitors , diuretics [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] and soy products in food .
 aimboth interstitial granulomatous dermatitis ( igd ) and palisaded neutrophilic granulomatous dermatitis ( pngd ) are rare disorders typically associated with systemic autoimmune conditions . 
 they probably represent different aspects of a disease spectrum encompassing the concept of autoimmunity - related granulomatous dermatitis ( argd).case reporta 61-year - old woman presented with argd and autoimmune hepatitis . 
 the clinical presentation suggested pngd , while histopathology was consistent with igd.discussionthe association of argd with autoimmune hepatitis is apparently a rare event . 
 the present case shows that the clinicopathological correlation in argd does not always clearly fit with the classical presentations of igd or pngd . 
Aim
Case Report
Discussion
Introduction
Case Report
Discussion
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