Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis

Abstract

Abstract:A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions. Keywords: Dermatitis; Granulomatous disease, chronic; Thyroiditis; Thyroiditis, autoimmune Resumo: Uma doente de 54 anos foi avaliada por placas eritematosas, dolorosas, disseminadas, recorrentes, com 3 meses de evolução. A biopsia cutânea foi compatível com dermatite intersticial granulomatosa. Os restantes exames laboratoriais revelaram hipotiroidismo e anticorpos anti-tiroideus positivos. Apesar da normalização da função tiroideia e de tratamento com corticóide tópico de alta potência, a dermatose melhorou apenas parcialmente. Dermatite intersticial inflamatória é um diagnóstico histopatoló-gico, com expressão clínica variável. Tem sido associada a vários fármacos, doenças linfoproliferativas e autoimunes, nomeadamente artrite reumatóide, lupus eritematoso sistémico e vasculites, mas a associação com tireoidite autoimune é rara. Até ao momento, não foi definido nenhum tratamento específico, mas os corticóides tópicos são dos fármacos mais utilizados. A doença caracteriza-se por períodos de agravamento e remissão.

Ackerman syndrome: a rare cause of arthritis with dermatitis

“…It is a distinct histopathological entity that is associated with a number of autoimmune conditions, including rheumatoid arthritis,1 systemic lupus erythaematosus,2–6 autoimmune thyroiditis,7 antiphospholipid syndrome,8 etc. It is, therefore, postulated to have an immune-mediated aetiology 9.…”

Interstitial granulomatous dermatitis with arthritis

“…2,3 However, other cutaneous lesions have also been described, such as erythematous or hyperchromic papules, subcutaneous plaques, and lesions with annular shapes, which generally affect the side walls of the thorax, armpits, abdomen, and medial surface of the thighs. 3-5 …”

“…1,4,5 IGDA mainly affects middle-aged women, the rheumatoid factor may be positive or not, and it is associated with a wide range of diseases, such as systemic erythematous lupus, antiphospholipid antibody syndrome, auto-immune thyroiditis, autoimmune hepatitis, Churg-Strauss syndrome, Behcet's disease, pulmonary paracoccidioidomycosis, pulmonary silicosis, chronic uveitis, and paraneoplastic syndrome. 1-5 However, the most common association is with rheumatoid arthritis. 3 …”

“…3-5 In this patient's case, joint involvement was investigated, thus excluding, initially, the diagnosis of autoimmune disease and drugs as causal factors.…”

“…In addition, it is common to see neutrophils and eosinophils in the infiltrate, which can also contain multinucleated and even atypical histiocytes. 1,3,5 When associated with medication, it may be histopathologically distinguishable through the presence of vacuolar interface dermatitis, exocytosis of lymphocytes, and the absence of neutrophils. 3 …”