Palisaded Granulomatous Dermatitis Associated with Ulcerative Colitis: A Comprehensive Literature Review

Abstract

Palisaded granulomatous dermatitis is an uncommon pathologic condition potentially associated with several disorders. These include drugs, inflammatory bowel disease, multiple myelomas, rheumatoid arthritis, and systemic lupus erythematosus. An illustrative case of a man with palisaded granulomatous dermatitis who subsequently developed ulcerative colitis is described, and the characteristics of other individuals with ulcerative colitis-associated palisaded granulomatous dermatitis are reviewed. PubMed was used to search the following terms: palisaded, interstitial, granulomatous, dermatitis, ulcerative colitis, and neutrophilic. Papers were obtained and references were reviewed. Ulcerative colitis-associated palisaded granulomatous dermatitis is uncommon. Palisaded granulomatous dermatitis-associated ulcerative colitis has been reported in four individuals. The palisaded granulomatous dermatitis appeared from six years prior to diagnosis to 19 years following diagnosis of the patient’s gastrointestinal disease. In addition to individual and grouped papular lesions on the elbows, the morphology of palisaded granulomatous dermatitis can also present as indurated linear plaques overlying the metacarpophalangeal (MCP) joints and proximal fingers.

A case of palisaded neutrophilic granulomatous dermatitis with subsequent development of chronic myelomonocytic leukemia

“…Palisaded neutrophilic granulomatous dermatitis is benign disease and its management is based on the control of the underlying disease . However, plenty therapeutic options have been reported such as systemic corticosteroids, colchicine, cyclosporine, cyclophosphamide, hydroxychloroquine, and dapsone . In our case, no action was taken, since the patient passed away a few days after the diagnosis of his hematologic condition, due to cardiac arrest.…”

“…Palisaded neutrophilic granulomatous dermatitis (PNGD) is an infrequent histopathological diagnosis usually associated with an underlying systemic disease, 1 such as connective tissue disease, rheumatoid arthritis, sarcoidosis, lymphoproliferative disorder, vasculitis, infection, and inflammatory bowel disease. 2,3 Infrequently, PNGD may be either idiopathic, with no identified cause, or drug-induced. [4][5][6] PNGD may precede or occur concomitantly with the underlying disease.…”

Palisaded Neutrophilic and Granulomatous Dermatitis in a Patient with Behçet's Disease: A Case Report

“…The histopathologic appearance of PNGD vary from diffuse interstitial inflammation composed of histiocytes or lymphocytes or eosinophils, and/or little neutrophils to dense neutrophilic infiltrates with degenerated collagen and palisading granulomas with fibrosis and scant neutrophilic debris 10 11 . Early lesions show dense neutrophilic infiltrates with or without leukocytoclastic vasculitis and degenerated collagen.…”

“…In this case, the histologic findings were consistent with fully developed lesions. Each developmental stage has a specific differential diagnosis such as leukocytoclastic vasculitis, rheumatoid nodules, granuloma annulare, and necrobiosis lipoidica 2 11 . Compared with leukocytoclastic vasculitis, PNGD has much more neutrophilic infiltrations and nuclear dust throughout the dermis and it also shows more severe collagen degenerations 12 13 .…”

“…Compared with leukocytoclastic vasculitis, PNGD has much more neutrophilic infiltrations and nuclear dust throughout the dermis and it also shows more severe collagen degenerations 12 13 . Rheumatoid nodules are generally deeper in the dermis and have more sclerosis in the area surrounded by the granuloma 11 . Granuloma annulare has far fewer nuclear debris, thinner degenerated collagen and more abundant mucin deposits.…”