Palisaded Neutrophilic Granulomatous Dermatitis Associated with Adult Onset Still's Disease

Abstract

A 66-year-old male presented with a new onset of rash. The rash was erythematous, macular and localized to the shoulders and neck. Biopsy showed palisading neutrophilic granulomatous dermatitis with features of atypical granuloma annulare tissue. Improvement was noted with steriods. To our knowledge, there has only been one reported case of PNGD in a patient with AOSD. It is diagnosed with skin biopsy and historically glucocorticoids have been the mainstay of treatment. However, clinicians should have a high suspicion of PNGD in patients with AOSD who present with features of atypical rash, as treatment may be required. This association is extremely rare, since this is only the second reported case. We strongly believe that to further delineate different forms of PNGD and rare instances such as in patients with AOSD, further case reports are needed. Additional research into the pathophysiology of PNGD is also warranted, as this would optimize medical management.