Annulare With Tuberculosis and Cutis Laxa: A Rare Case Report

Abstract

Introduction: Granuloma annulare (GA) is a benign, noninfectious granulomatous disorder of unknown etiology, characterized by an annular arrangement of erythematous small nodules and plaques, classically localized on dorsal surfaces of the hands and feet. GA shows palisading granulomas with a central zone of necrobiotic collagen and mucin deposition surrounded by a palisade of histiocytes. Here, we reported a 24-year-old man with GA combined with tuberculosis and cutis laxa. Case presentation: A 24-year-old man was presented with skin annular lesions on the trunk and extremities without subjective symptoms for three years. The annular lesions first arose in the trunk that slowly progressed to most parts of the body and cutis laxa-like lesions appeared on the left inguinal region with inguinal hernia two years ago. At the same time, the patient was diagnosed with pulmonary tuberculosis due to the hemoptysis for two years and the sputum culture for tuberculosis bacillus was positive. He was treated with triple anti-tuberculosis drugs regularly. Partial remission of the skin lesions was noted since then. Pathological examination showed similar histological changes in the interstitial pattern of GA. Discussion: Tuberculosis was a possible etiologic factor in GA because of the coincidental occurrence, granulomatous histologic features, and positive tuberculin skin tests. In fact, some cases of GA with chronic pulmonary tuberculosis responding to a specific anti-tuberculosis therapy were reported. It is worth noting that tuberculids, generalized exanthems in the skin of tuberculous patients possibly resulting from hypersensitivity reactions to the tubercle bacillus, may mimic GA. Furthermore, our patient also showed extremely characteristic slack skin in posterior lumbar and groin, which was deemed to be related to reduction and destruction of elastic fibers. Conclusion: Generalized interstitial GA with tuberculosis and cutis laxa is vary rare, which is worth being aware of the possibility of such a occurrence.