Abstract
Systemic lupus erythematosus (SLE) is a multi-system disease with a myriad of mucocutaneous and systemic findings. One of the atypical cutaneous manifestations is palisaded neutrophilic granulomatous dermatitis (PNGD). This uncommon condition presents as tender or asymptomatic, flesh-colored, red to violaceous subcutaneous nodules. The diagnosis may be suspected clinically but is confirmed by biopsy. The impact of the disease may be the direct result of pain, psychosocial, cosmetic concerns, or be the initial presentation of an underlying systemic disease. We present a patient with known SLE who developed PNGD. We also review similar clinical and microscopic disease entities with a summative comparison of neutrophilic dermatoses in patients with autoimmune connective tissue diseases.
Highlights
Palisaded neutrophilic granulomatous dermatitis (PNGD) is a neutrophilic dermatosis associated with a characteristic phenotype of characteristic subcutaneous nodules overlying extensor surfaces, knuckles, and extremities.[1]
We present a patient with known systemic lupus erythematosus (SLE) who developed multiple tender, violaceous, subcutaneous nodules, and was subsequently diagnosed with PNGD
PNGD is a cutaneous manifestation of multiple underlying disease states but can be encountered in patients with lupus erythematosus
Summary
Palisaded neutrophilic granulomatous dermatitis (PNGD) is a neutrophilic dermatosis associated with a characteristic phenotype of characteristic subcutaneous nodules overlying extensor surfaces, knuckles, and extremities.[1] PNGD may be seen in association with lymphoproliferative disorders, inflammatory bowel diseases, medications, and autoimmune connective tissue diseases. Rheumatoid arthritis is the most common underlying disease, systemic lupus erythematosus (SLE) has been encountered. We present a patient with known SLE who developed multiple tender, violaceous, subcutaneous nodules, and was subsequently diagnosed with PNGD. The patient reported allergy and intolerance certain first-line therapies, but oral corticosteroids led to the improvement of symptoms and over a period of months improvement of skin lesions. A middle-age African American woman was sent to our outpatient dermatology office through an internal referral from rheumatology within a large multidisciplinary private practice. The patient’s chief complaint was swollen red hands and
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