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Necrobiotic xanthogranuloma associated with necrotizing scleritis.

Abstract

A 57-year-old man presented to the ophthalmology clinic with a red right eye. He denied pain, diplopia, tearing, and blurred vision. His medical history included asymptomatic annular plaques on the trunk and extremities for at least a decade. Ophthalmological examination revealed a necrotizing scleritis of the right eye. Examination of the skin demonstrated variable sized annular plaques with central atrophy, some with prominent indurated border and yellow discoloration. No periorbital lesions were present. The ocular lesion rapidly progressed and areas of scleral melting developed in the right eye, which eventually required a scleral patch graft. The left eye also developed necrotizing scleritis with areas of scleral melting. Two sets of skin biopsies were performed a few weeks apart. An initial set of skin punch biopsies revealed extensive palisading granulomatous inflammation throughout the dermis, extending into the subcutis. The accompanying perivascular mononuclear infiltrate contained the collections of plasma cells. Scattered multinucleated giant cells were noted. The possibility of necrobiosis lipoidica diabeticorum was suggested. Subsequent skin biopsies showed more prominent and extensive necrobiosis, raising the possibility of necrobiotic xanthogranuloma. Protein electrophoresis was performed, which revealed an IgG λ monoclonal protein.

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  • Authors+Show Affiliations

    ,

    Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.

    , , , ,

    Source

    MeSH

    Biopsy
    Disease Progression
    Giant Cells
    Humans
    Male
    Middle Aged
    Necrobiotic Xanthogranuloma
    Plasma Cells
    Scleritis
    Skin

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    22814320

    Citation

    Peyman, Amir, et al. "Necrobiotic Xanthogranuloma Associated With Necrotizing Scleritis." The American Journal of Dermatopathology, vol. 34, no. 6, 2012, pp. 644-7.
    Peyman A, Walsh N, Green P, et al. Necrobiotic xanthogranuloma associated with necrotizing scleritis. Am J Dermatopathol. 2012;34(6):644-7.
    Peyman, A., Walsh, N., Green, P., Dorey, M. W., Seamone, C., & Pasternak, S. (2012). Necrobiotic xanthogranuloma associated with necrotizing scleritis. The American Journal of Dermatopathology, 34(6), pp. 644-7. doi:10.1097/DAD.0b013e318234e73c.
    Peyman A, et al. Necrobiotic Xanthogranuloma Associated With Necrotizing Scleritis. Am J Dermatopathol. 2012;34(6):644-7. PubMed PMID: 22814320.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Necrobiotic xanthogranuloma associated with necrotizing scleritis. AU - Peyman,Amir, AU - Walsh,Noreen, AU - Green,Peter, AU - Dorey,Michael W, AU - Seamone,Christopher, AU - Pasternak,Sylvia, PY - 2012/7/21/entrez PY - 2012/7/21/pubmed PY - 2013/3/30/medline SP - 644 EP - 7 JF - The American Journal of dermatopathology JO - Am J Dermatopathol VL - 34 IS - 6 N2 - A 57-year-old man presented to the ophthalmology clinic with a red right eye. He denied pain, diplopia, tearing, and blurred vision. His medical history included asymptomatic annular plaques on the trunk and extremities for at least a decade. Ophthalmological examination revealed a necrotizing scleritis of the right eye. Examination of the skin demonstrated variable sized annular plaques with central atrophy, some with prominent indurated border and yellow discoloration. No periorbital lesions were present. The ocular lesion rapidly progressed and areas of scleral melting developed in the right eye, which eventually required a scleral patch graft. The left eye also developed necrotizing scleritis with areas of scleral melting. Two sets of skin biopsies were performed a few weeks apart. An initial set of skin punch biopsies revealed extensive palisading granulomatous inflammation throughout the dermis, extending into the subcutis. The accompanying perivascular mononuclear infiltrate contained the collections of plasma cells. Scattered multinucleated giant cells were noted. The possibility of necrobiosis lipoidica diabeticorum was suggested. Subsequent skin biopsies showed more prominent and extensive necrobiosis, raising the possibility of necrobiotic xanthogranuloma. Protein electrophoresis was performed, which revealed an IgG λ monoclonal protein. SN - 1533-0311 UR - https://www.unboundmedicine.com/medline/citation/22814320/Necrobiotic_xanthogranuloma_associated_with_necrotizing_scleritis_ L2 - http://Insights.ovid.com/pubmed?pmid=22814320 DB - PRIME DP - Unbound Medicine ER -