Palisaded neutrophilic granulomatous dermatitis associated with systemic lupus erythematosus presenting with the burning rope sign

• Published in: Journal of the American Academy of Dermatology Vol. 61; no. 4; pp. 711 - 714
• Main Authors: Gulati, Abha, MRCP, Paige, David, FRCP, Yaqoob, Magdi, PhD, FRCP, Proby, Charlotte M., FRCP, Cerio, Rino, FRCP, FRCPath, Harwood, Catherine A., FRCP, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.10.2009; Elsevier
• Subjects: Adult; Biological and medical sciences; Dermatitis - etiology; Dermatitis - pathology; Dermatology; Female; Granuloma - etiology; Granuloma - pathology; Humans; Hyperpigmentation - etiology; Hyperpigmentation - pathology; Lupus Erythematosus, Systemic - complications; Medical sciences; Neutrophils - pathology; palisaded neutrophilic granulomatous dermatitis; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Skin - pathology; Skin involvement in other diseases. Miscellaneous. General aspects; SLE; SLE; palisaded neutrophilic granulomatous dermatitis; Immunopathology; Connective tissue disease; Symptomatology; Skin disease; Systemic lupus erythematosus; Neutrophilic dermatosis; Dermatology; Systemic disease; Autoimmune disease; Inaugural sign
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2008.12.016

Palisaded neutrophilic granulomatous dermatitis is a rare but increasingly recognized cutaneous manifestation of connective tissue disorders. It is reported most commonly with rheumatoid arthritis but also occasionally in association with systemic lupus erythematosus, inflammatory bowel disease, lymphoproliferative disorders, and systemic vasculitides. The clinicopathological presentation is highly variable, which has led to suggestions that it encompasses a number of distinct diseases. Most previous cases have reported only a single clinical and histologic manifestation of the condition within an individual. Here, we present a case of systemic lupus erythematosus–associated palisaded neutrophilic granulomatous dermatitis in which a striking evolution of both clinical and histologic features was observed during the course of 7 years, providing compelling evidence for the proposal that palisaded neutrophilic granulomatous dermatitis represents a disease spectrum rather than separate disease entities.