Remission of human immunodeficiency virus-associated generalized granuloma annulare under zidovudine therapy

Granuloma Annulare: A Focused Review of Therapeutic Options

Granuloma annulare (GA) is a benign inflammatory disease associated with many conditions such as malignancy, trauma, thyroid disease, diabetes mellitus, and HIV infection. Common clinical subtypes include localized GA, generalized GA, subcutaneous GA, perforating GA, and patch GA. There exists an abundance of literature on GA, yet we know relatively little about its exact etiology and even less about its treatment. The paucity of conclusive data on effective treatment options is largely because the majority of published studies are limited to small case reports, case series, and retrospective studies. As such, there does not yet exist a gold standard of care to guide clinical management. Depending on the clinical subtype, the clinical prognosis for GA can vary. The localized variant generally self-resolves within 2 years without treatment, whereas the generalized form is more chronic and less responsive to treatment. This focused up-to-date review serves to summarize the latest therapeutic options available for GA.

[Generalized granuloma annulare: remission during treatment of HIV infection]

INTRODUCTION

Granuloma annulare is a benign dermatosis characterized by pale or erythematous papules grouped in rings or in arch form figures. We report the observation combining a granuloma annulare and a Human Immunodeficiency Virus (HIV) infection, with regression of the granuloma annulare on initiation of treatment of the HIV infection.

OBSERVATION

A 33 year-old man presented with an eruption of multiple, erythematous papules predominating on the trunk and limbs but sparing the face. Histology confirmed the diagnosis of generalized granuloma annulare. We diagnosed an HIV infection. Remission of the granuloma annulare was obtained concomitantly when immune restoration was obtained following the prescription of an antiretroviral tritherapy.

DISCUSSION

Since 1985, several cases of atypical forms of granuloma annulare have been reported in HIV-infected patients. Nevertheless, the precise relationship between the two diseases is unknown. The case we report on raises the question of the relationship between granuloma annulare and immunodepression.

An unusual presentation of diffuse granuloma annulare in an HIV-positive patient - immunohistochemical evidence of predominant CD8 lymphocytes

Over the past decade there have been several reports in the literature of atypical forms of granuloma annulare (GA) occurring in HIV positive patients. We now report a case of diffuse granuloma annulare in an HIV positive patient with unusual clinical and immunohistological features. Our patient presented with a persistent extensive macular erythematous eruption on his face and upper trunk with bizarre sparing around the nipples and axillae. The histology showed an interstitial pattern of GA, with a predominance of CD8 positive cells, in contrast to the usual CD4 positive infiltrate typically seen in GA.

Granuloma annulare of the penis

Granuloma annulare is an uncommon skin condition, most often found on the extremities of young females. A case of granuloma annulare occurring on the penis of a 61 year old man is reported and the current literature associating granuloma annulare and conditions likely to present to genitourinary clinics is reviewed.