Interstitial granulomatous dermatitis with plaques associated with antiphospholipid syndrome

Non-Infectious Granulomatous Diseases of the Skin and their Associated Systemic Diseases

“…[58,[60][61][62][63][64] Similarly, IGD has been described in patients with autoimmune diseases such as arthritis, autoimmune hepatitis, and in the presence of various autoantibodies including the antiphospholipid syndrome. [65][66][67][68] However, IGD has also been observed in patients with hematologic malignancy; [19] those taking medications such as tumor necrosis factor-a inhibitors, [69] ACE inhibitors, and diuretics; [70] and as a reaction to foods including soy products. [71] Further confusion among these conditions has arisen with the term interstitial granulomatous drug reaction (IGDR), a condition that appears similar to macular GA and occurs more commonly on the extremities.…”

The granulomatous reaction pattern

“…736 Some patients present with arthralgias. 718,725,727,728,[743][744][745][746][747][748][749] Various infections have been associated with interstitial granulomatous dermatitis or a pattern similar to it. Other terms used include 'rheumatoid papules' and 'palisaded neutrophilic and granulomatous dermatitis'.…”

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.…”

“…The associated conditions, for example, SLE or rheumatoid arthritis, could have a significant role in influencing the choice of agents. Treatment options include non-steroidal anti-inflammatory drugs,14 topical steroids,13 15 systemic steroids6 16 17 or any combination of these agents 8 18. Other available options for more resistant cases include methotrexate,19 anti-TNF agents,20 21 toclizumab,22 ustekinumab23 and IVIG 24.…”