Granuloma annulare and sarcoidosis

Abstract

Granuloma annulare (GA) and sarcoidosis are two diseases of unknown cause which involve the skin and whose basic pathology is a mononuclear histiocytic cellular reaction. Biopsy plays the major role in the diagnosis of both diseases, and no other routine laboratory test for either disease is currently available. Sarcoidosis is generally considered to be an allergic or immune granuloma with inconstant defects in cell-mediated immunity (Broom & MacLaurin, 1973). There have been no immunological studies of GA. We recently studied 14 cases and found circulating lymphokines (macrophage migration inhibition factor) in 11 which correlated with circulating macrophage migration inhibition factor in sarcoidosis (9 of 10 cases) (Umbert, Belcher & Winkelmann, 1976). The co-existence of GA and sarcoidosis in 5 patients suggests to us that there are very similar immunological reactions as well as pathology in both diseases and that the elucidation of the pathogenesis of one disease should aid in understanding the other. To our knowledge, there are no prior reports of systemic sarcoidosis coexisting with or manifesting the histological picture of GA. In this report we have demonstrated by clinical and histological criteria that GA and sarcoidosis can co-exist.

Cutaneous sarcoidosis

“…Cutaneous involvement may present a diagnostic challenge as sarcoidosis presents with varied morphologies (Table 1). 4,5 , 6 …”

Generalized granuloma annulare in a patient with myelocytic leukemia and chronic hepatitis B virus infection

“…Tumor cells may directly or indirectly cause secretion of cytokines; cytokine activation of fibroblasts might produce an inflammatory reaction that mediates the formation of a granuloma. In addition to patients with malignancy and tumor-related immunodeficiency, GA has also been observed in individuals with deficiencies in cell-mediated immunity, such as patients with HIV infection [7] or sarcoidosis; [8] this suggests that immunologic factors may have a role in the development of malignancy-associated GA. In most patients with malignancy, a diagnosis of cancer had previously been established, and the appearance of GA lesions was not temporally associated with detecting an underlying malignancy.…”

Autoimmune Thyroiditis and Generalized Granuloma annulare: Remission of the Skin Lesions after Thyroxine Therapy

“…In 5 patients a correlation with sarcoido sis has been described [10], The authors state that sarcoidosis, associated with defects in cellular immunity and granuloma annulare may have a similar immunopathological response. Nevertheless a correlation of sar coidosis and enhanced humoral immunity with raised immunoglobulin levels and non specific increased circulating antibody titers is found [11], Furthermore, other autoim mune diseases than diabetes mellitus have been found in association with granuloma annulare: morphea and sclerotic panat rophy [12] and autoimmune thyroiditis [1].…”