Histopathological Study of Infectious Granulomatous Skin Lesions

Abstract

Background: Granulomas are the commonest lesions that the pathologists come across in routine practice. Granulomatous inflammation is a distinctive pattern of chronic inflammation that is encountered in a number of infectious and non-infectious conditions. A definitive diagnosis made by demonstration of the etiological agent is essential, which will bear an impact on patient management and outcome.Methods: This is a retrospective study considering the cases of 2 years. The cases diagnosed as infectious granulomatous skin lesions by clinical presentation, histopathological study of skin biopsies of such patients attending our hospital since July 2010 to July 2012 were included in the study. Clinical history and relevant data were obtained from respective requisition forms of biopsies received. Results:The study includes 67 cases. A male predominance was noted with 47(70.14%) cases while females constituted 20(29.85%) cases. The study shows that 80% of cases are distributed between 21 to 50 yrs of age while the prevalence of infectious granulomatous dermatoses is highest in the age group of 21-30 yrs. Among the different types of infectious granulomatous dermatoses, leprosy contributed to the major etiology, followed by tuberculosis of skin, leishmaniasis and actinomycosis. Conclusion:Clinical data with the laboratory workup and special stains together are needed for the definitive diagnosis and management of patients with granulomatous lesions. Cooperation between clinician and pathologist is more important in the field of skin disease than in almost any other field if the patient is to derive the greatest benefit from the biopsy.

Pattern of granulomatous skin lesions in a tertiary care centre of western Uttar Pradesh

“…4 An identical histologic picture is produced by several causes and conversely a single cause may produce varied histologic pattern. 5 Out of the total 138 cases included in the present study age and sex distribution revealed that majority of cases belonged to the age group of 21-40 years, 68 (49.28%) cases followed by 41-60 6 Also, similar findings were reported with Permi et al and Potekar et al 7,8 A contrasting result was seen with Queiros et al who had 51-60 years as the most common age group for presentation. 9 Our study showed a male preponderance 98 (71.01%) cases, whereas by females were 40(28.99%) cases with M:E ratio of 1.9:1.…”

“…The findings are concordant with those of Potekar et al in which lupus vulgaris constituted 2(2.98%) cases as commonest subtype. 8 The present study showed that out of total 138 cases, 26(18.84%) showed concordance between clinical and histopathological diagnosis, 98(71.01%) cases showed partial consistency and 14(10.14%) cases were discordant. Vaishali R Makwana et al showed that out of 105 cases, 69(65.7%) were concordant, 16(15.23%) cases were discordant and 20(19.04%) cases were undecided.…”

“…Similar findings were reported by Rajbhandari et al and Potekar et al with a higher rate in males preponderance. 3,8 However the findings were in contrasting with those of Zafar et al and Kumbar et al which showed female preponderance (57.3%) and (52.77%) cases respectively. 10,11 In the present study the spectrum showed that infectious causes are the commonest etiology of granulomtous pathology 130(86.96%) cases out of 138 cases were affected followed by non-infectious causes 2(1.45%) patients.…”

“…15 The finding are however discordant with those of Ahmed et al in which borderline tuberculoid leprosy 22.86% was the commonest subtype of leprosy and Potekar et alwho also had borderline tuberculoid leprosy as the commonest cause(25.37%). 8,14 After leprosy the next most common cause among infectious etiology is cutaneous tuberculosis (13/130 cases), with lupus vulgaris being the commonest subtype 11(8.33%). The findings are concordant with those of Potekar et al in which lupus vulgaris constituted 2(2.98%) cases as commonest subtype.…”