Generalized annular granuloma
after initiation of therapy with beta
blockers for glaucoma
-case reportAndreea Stancu* , Aurel Doru Chirita**, Irina Margaritescu**
• * Dermatology Department, „Carol Davila” Central University
Emergency Military Hospital, Bucharest
• ** Dermatopathology Department, „Domina-Sana” Medical Center,
Bucharest
Introduction
• Granuloma annulare (GA) is a benign
inflammatory dermatosis
• Granuloma annulare is a relatively common
disease that occurs in all age groups
• Characterized:
– clinically by dermal papules and annular
plaques
– histologically by foci of degenerative collagen
associated with palisaded granulomatous
inflammation
Clinical case
 We report a case of a
59 years-old women
who presented with a
3 months history of
pruritic papules,
patches and well
circumscribed plaques
 The lesions appeared
first on the abdomen
and anterior thorax
and in a few days they
became generalized
Clinical case
Disseminated erythematous papules, patches,
plaques
 Granulomatous nodular dermatitis with superficial and deep
perivascular infiltrate of lymphocytes and histiocytes arranged in
a palisade around a locus that consists mostly of mucin, and
degenerated collagen bundlles
Histiocytes in a palisade and scattered interstitially
Degeneration of collagen
Deposits of mucin
Interstitial lymphocytes and epithelioid histiocytes
Discussion
• Granuloma annulare can present with two
different histologic patterns:
Palisaded
Interstitial
Our case have findings of both palisaded and
interstitial patterns
Conclusions
• Although the aetiology and pathogenesis of
granuloma annulare are unclear, it appears likely
that it represents a reaction pattern to a variety
of triggering factors
• Because lesions started after the initiation of the
B-blocker treatment we suspected a drug
reaction
• Treatment:
– discontinuation of culprit drug
– Corticosteroids
– PUVA-therapy