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Direct Immunofluorescence Results of a Case of Railway Track Dermatitis
Author(s) -
Mecca P.,
Carlson J. A.
Publication year - 2005
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.0303-6987.2005.320et.x
Subject(s) - medicine , granuloma annulare , anti nuclear antibody , immunoglobulin d , pathology , arthritis , dermatology , leflunomide , rheumatoid arthritis , immunology , antibody , autoantibody , b cell
A 40 year‐old female with sero‐negative arthritis presented with annular and cord‐like configurations (rope sign) of asymptomatic papules and plaques along her flanks, suspected to be granuloma annulare. Medications at the time of presentation included methotrexate, prednisone, Vioxx (rofecoxib), Arava (leflunomide) and Remicade (infliximab). High‐potency topical corticosteroids did not alleviate the eruption. Biopsy was performed demonstrating a deep dermal, interstitial and focally palisading granulomatous infiltrate with eosinophils. Dermal lymphangiectases were present, and the epidermis was unaffected. Direct immunofluorescence (DIF) examination showed deep dermal, interstitial IgG, C3, and IgM deposits coating collagen bundles centered in the granulomatous infliltrate and IgG antinuclear keratinocyte reactivity. Serologic tested also revealed anti‐nuclear antibodies. No other auto‐antibodies were detected. Based on these findings, this patient was diagnosed with “interstitial granulomatous dermatitis (IGD) with cords and arthritis”. Thirteen cases of IGD with cords were identified in a literature review of which 7/12 (58%) were sero‐(rheumatoid factor)‐negative, 3/5 (60%) were anti‐nuclear antibody positive, and 12/13 (92%) had arthritis. One theory of pathogenesis is that immune‐complex deposition in the dermis initiates a granulomatous reaction; DIF findings in this case support this proposed mechanism. IGD with cords is a singular clinicopathologic entity associated with sero‐negative, non‐erosive arthritis and antinuclear antibodies.