Atypical Lichen Myxedematosus with an Interstitial Granulomatous Pattern; A Difficult Case in Making Diagnosis
Keywords:
Atypical lichen myxedematosus, scleromyxedema, interstitial granulomatousAbstract
Lichen myxedematosus (LM) is characterized by multiple discrete papules with shiny surface and area of induration caused by mucin deposition. There are 3 subtypes including the generalized papular and sclerodermoid form or scleromyxedema, the localized papular form, and the atypical or intermediate form. Histological characteristics can be classical mucin deposition or rare interstitial granuloma annulare variant. The authors report an atypical case of LM with an interstitial granuloma histologic pattern which was rare and difficult to make a diagnosis.
References
1. Knobler R, Moinzadeh P, Hunzelmann N, et al. European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis. J Eur Acad Dermatol Venereol. 2017; 31: 1581-94.
2. Rongioletti F, Rebora A. Updated classification of papular mucinosis, lichen myxedematosus, and scleromyxedema. J Am Acad Dermatol 2001; 44: 273-81.
3. Rongioletti F. Lichen myxedematosus (papular mucinosis): new concepts and perspectives for an old disease. Semin Cutan Med Surg. 2006; 25: 100-4.
4. Rongioletti F, Merlo G, Cinotti E, et al. Scleromyxedema: a multicenter study of characteristics, comorbidities, course, and therapy in 30 patients. J Am Acad Dermatol. 2013; 69: 66-72.
5. Macnab M, Kenny P. Successful intravenous immunoglobulin treatment of atypical lichen myxedematosus associated with hypothyroidism and central nervous system involvement: case report and discussion of the literature. J Cutan Med Surg. 2013; 17: 69-73.
6. Lopez-Lerma I, Fernandez-Codina A, Hilari H, Ferrer B, Selva-O'Callaghan A, Garcia-Patos V. Atypical scleromyxedema with prominent nodular lesions associated with immune thrombocytopenia: an unusual presentation. J Am Acad Dermatol. 2014; 71: e158-9.
7. Açikgöz G, Özmen I, Hüseynov S, et al. A case of atypical scleromyxedema without gammopathy treated with cyclosporine. Indian J Dermatol Venereol Leprol. 2014; 80: 278.
8. Thomas E, George A, Deodhar D, John M. Scleromyxedema: An Atypical Case. Indian J Dermatol. 2015; 60: 323.
9. Prylutskyi O, Prylutska O, Degonskyi A, Tkachenko K. A Case of Autoimmune Polyglandular Syndrome type 2 Associated with Atypical Form of Scleromyxedema. Ethiop J Health Sci. 2016; 26: 503-7.
10. Teh SA, Kandiah DA. Atypical scleromyxedema presenting with cutaneous and cardiovascular manifestations. Int Med Case Rep J.2016; 9: 295- 9.
11. Gomathy M, Sunny B, Anitha K, Sreekanth S, Rajeevan K, Das SC. Atypical Lichen Myxedematosus: A Case with Remarkable Response to Low Dose Melphalan. Indian Dermatol Online J. 2017; 8: 198-200.
12. Rongioletti F, Rebora A. Cutaneous mucinoses: microscopic criteria for diagnosis. Am J Dermatopathol. 2001; 23: 257-67.
13. Rongioletti F, Merlo G, Carli C, et al. Histopathologic characteristics of scleromyxedema: A study of a series of 34 cases. J Am Acad Dermatol. 2016; 74: 1194-200.
14. Rongioletti F, Cozzani E, Parodi A. Scleromyxedema with an interstitial granulomatous-like pattern: a rare histologic variant mimicking granuloma annulare. J Cutan Pathol. 2010; 37: 1084-7.
15. Stetsenko GY, Vary JC Jr, Olerud JE, Argenyi ZB. Unusual granulomatous variant ofscleromyxedema. J Am Acad Dermatol. 2008; 59: 346-9.
16. Mullangi S, Granter SR, Laubach JP, Lipworth AD. Scleromyxedema with histology resembling granuloma annulare. Dermatol Online J. 2014; 21.
17. Akarsu S, Ozbagcivan O, Ilknur T, Lebe B, Fetil E. An interstitial granulomatous pattern in scleromyxedema with dermato-neuro syndrome. J Eur Acad Dermatol Venereol. 2016; 30: 687-9.
18. Shlyankevich J, Stetsenko GY, George E, Lantz DM, Burwick NR, Vary JC Jr. Granulomatous scleromyxedema: case report and literature review. Am J Dermatopathol. 2015; 37: 240-5.
19. Bolton JG, Satter EK. An interstitial granulomatous pattern in localized lichen myxedematosus with associated monoclonal gammopathy. J Cutan Pathol. 2012; 39: 395-8.
20. Long V, Tan W, Lee SSJ, Thng TGS. Interstitial Granulomatous Variant of Scleromyxedema-A Diagnostic Pitfall. Am J Dermatopathol. 2018; 40: 279-82.
21. Knobler R, Moinzadeh P, Hunzelmann N, et al. European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes. J Eur Acad Dermatol Venereol. 2017; 31: 1401-24.
2. Rongioletti F, Rebora A. Updated classification of papular mucinosis, lichen myxedematosus, and scleromyxedema. J Am Acad Dermatol 2001; 44: 273-81.
3. Rongioletti F. Lichen myxedematosus (papular mucinosis): new concepts and perspectives for an old disease. Semin Cutan Med Surg. 2006; 25: 100-4.
4. Rongioletti F, Merlo G, Cinotti E, et al. Scleromyxedema: a multicenter study of characteristics, comorbidities, course, and therapy in 30 patients. J Am Acad Dermatol. 2013; 69: 66-72.
5. Macnab M, Kenny P. Successful intravenous immunoglobulin treatment of atypical lichen myxedematosus associated with hypothyroidism and central nervous system involvement: case report and discussion of the literature. J Cutan Med Surg. 2013; 17: 69-73.
6. Lopez-Lerma I, Fernandez-Codina A, Hilari H, Ferrer B, Selva-O'Callaghan A, Garcia-Patos V. Atypical scleromyxedema with prominent nodular lesions associated with immune thrombocytopenia: an unusual presentation. J Am Acad Dermatol. 2014; 71: e158-9.
7. Açikgöz G, Özmen I, Hüseynov S, et al. A case of atypical scleromyxedema without gammopathy treated with cyclosporine. Indian J Dermatol Venereol Leprol. 2014; 80: 278.
8. Thomas E, George A, Deodhar D, John M. Scleromyxedema: An Atypical Case. Indian J Dermatol. 2015; 60: 323.
9. Prylutskyi O, Prylutska O, Degonskyi A, Tkachenko K. A Case of Autoimmune Polyglandular Syndrome type 2 Associated with Atypical Form of Scleromyxedema. Ethiop J Health Sci. 2016; 26: 503-7.
10. Teh SA, Kandiah DA. Atypical scleromyxedema presenting with cutaneous and cardiovascular manifestations. Int Med Case Rep J.2016; 9: 295- 9.
11. Gomathy M, Sunny B, Anitha K, Sreekanth S, Rajeevan K, Das SC. Atypical Lichen Myxedematosus: A Case with Remarkable Response to Low Dose Melphalan. Indian Dermatol Online J. 2017; 8: 198-200.
12. Rongioletti F, Rebora A. Cutaneous mucinoses: microscopic criteria for diagnosis. Am J Dermatopathol. 2001; 23: 257-67.
13. Rongioletti F, Merlo G, Carli C, et al. Histopathologic characteristics of scleromyxedema: A study of a series of 34 cases. J Am Acad Dermatol. 2016; 74: 1194-200.
14. Rongioletti F, Cozzani E, Parodi A. Scleromyxedema with an interstitial granulomatous-like pattern: a rare histologic variant mimicking granuloma annulare. J Cutan Pathol. 2010; 37: 1084-7.
15. Stetsenko GY, Vary JC Jr, Olerud JE, Argenyi ZB. Unusual granulomatous variant ofscleromyxedema. J Am Acad Dermatol. 2008; 59: 346-9.
16. Mullangi S, Granter SR, Laubach JP, Lipworth AD. Scleromyxedema with histology resembling granuloma annulare. Dermatol Online J. 2014; 21.
17. Akarsu S, Ozbagcivan O, Ilknur T, Lebe B, Fetil E. An interstitial granulomatous pattern in scleromyxedema with dermato-neuro syndrome. J Eur Acad Dermatol Venereol. 2016; 30: 687-9.
18. Shlyankevich J, Stetsenko GY, George E, Lantz DM, Burwick NR, Vary JC Jr. Granulomatous scleromyxedema: case report and literature review. Am J Dermatopathol. 2015; 37: 240-5.
19. Bolton JG, Satter EK. An interstitial granulomatous pattern in localized lichen myxedematosus with associated monoclonal gammopathy. J Cutan Pathol. 2012; 39: 395-8.
20. Long V, Tan W, Lee SSJ, Thng TGS. Interstitial Granulomatous Variant of Scleromyxedema-A Diagnostic Pitfall. Am J Dermatopathol. 2018; 40: 279-82.
21. Knobler R, Moinzadeh P, Hunzelmann N, et al. European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes. J Eur Acad Dermatol Venereol. 2017; 31: 1401-24.
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Published
2018-12-04
How to Cite
Ungaksornpairote, C., & Mahaisawariya, P. (2018). Atypical Lichen Myxedematosus with an Interstitial Granulomatous Pattern; A Difficult Case in Making Diagnosis. Thai Journal of Dermatology, 34(3), 207–216. Retrieved from https://he02.tci-thaijo.org/index.php/TJD/article/view/158913
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