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The Cutting Edge: Challenges in Medical and Surgical Therapies |

Interstitial Granulomatous Dermatitis With Arthritis Responding to Tocilizumab

Stefan Schanz, MD; Marc Schmalzing, MD; Emmanuella Guenova, MD; Gisela Metzler, MD; Anja Ulmer, MD; Ina K ötter, MD; Gerhard Fierlbeck, MD
Arch Dermatol. 2012;148(1):17-20. doi:10.1001/archdermatol.2011.341.
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A 68-year-old man was referred with interstitial granulomatous dermatitis with arthritis involving a large area of his skin. Different treatment approaches remained unsuccessful. Finally, we initiated a treatment with tocilizumab. The response was promising.

Departments of Dermatology (Drs Schanz, Guenova, Metzler, Ulmer, and Fierlbeck) and Internal Medicine II (Dr Schmalzing) and Interdisciplinary Center for Rheumatology, Immunology, and Autoimmune Diseases (Drs Schanz, Schmalzing, Guenova, K ötter, and Fierlbeck), University of Tuebingen, Tuebingen, GermanyCorrespondence: Stefan Schanz, MD, Department of Dermatology, University of Tuebingen, Liebermeisterstrasse 25, Tuebingen, 72076 Germany (stefan.schanz@med.uni-tuebingen.de).

Accepted for Publication: August 7, 2011.

Author Contributions: Drs Schanz and Schmalzing contributed equally to this work. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis and contributed in the treatment of this patient. Study concept and design: Guenova, Schanz, and Schmalzing. Analysis and interpretation of data: Schanz, Schmalzing, Guenova, Metzler, Ulmer, K ötter, and Fierlbeck. Critical revision of the manuscript for important intellectual content: Guenova, Metzler, Ulmer, K ötter, and Fierlbeck. Administrative, technical, and material support: Schanz, Schmalzing, Guenova, Metzler, Ulmer, K ötter, and Fierlbeck. Study supervision: Schanz, Schmalzing, Guenova, Metzler, Ulmer, K ötter, and Fierlbeck.

Financial Disclosure: None reported.

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Figure 1. Disseminated and confluent cutaneous erythematous and flesh-colored papules before treatment with tocilizumab. A, Chest and stomach. B, Back. C, Close-up view of the lumbar region.

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Figure 2. Histologic presentation. A, Central necrobiosis surrounded by histiocytes in a palisade pattern (hematoxylin-eosin, original magnification ×40). The granuloma is infiltrated by neutrophilic granulocytes and nuclear dust. B, Neutrophilic infiltrate within and around the vessel wall of a dermal artery (hematoxylin-eosin, original magnification ×200). C, Toluidine stain without evidence of mucin (original magnification ×40).

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Figure 3. Complete disappearance of the painful cutaneous papules under therapy with tocilizumab. A, Chest and stomach. B, Back.

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