Home   Chapter Home   Jobs   Conferences   Fellowships   Books



Granulomatous but non-infectious disorders

Interstitial granulomatous dermatitis with arthritis

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 26 October 2011, last major update June 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● Uncommon; first described in 1993
● Linear inflammatory indurations on lateral aspects of trunk (“rope sign”), also plaques or papules associated with systemic connective tissue disease
● Usually in women
● Arthritis is usually symmetric and involves fingers, wrists, elbows and shoulders
● Associated with positive rheumatoid factor (not always), autoantibodies and elevated erythrocyte sedimentation rate


● Systemic corticosteroids
● Dapson was useful in patients with rheumatoid papules

Case reports

● 34 year old woman with SLE and a skin rash (Case of Week #221)
● 54 year old woman with arthritis (Dermatol Online J 2009;15:22)
● Disease without rope sign (Hum Pathol 2004;35:892)

Clinical images

Plaque on thigh

Micro description

● Diffuse dense inflammatory infiltrate of histiocytes within reticular dermis, focal degenerated collagen and elastic fibers, palisading histiocytes
● Variable neutrophils, eosinophils, lymphocytes, mucin and vasculitis
● Less mucin than granuloma annulare
● Palisading of histiocytes and lymphocytes around a central zone of numerous neutrophils

Micro images

Superficial and deep perivascular and interstitial infiltrate of lymphocytes, eosinophils and histiocytes; histiocytes are scattered between collagen bundles and associated with mucin deposits

Positive stains

● Direct immunofluorescence (DIF) may demonstrate C3, IgM and fibrinogen in dermal blood vessels

Differential diagnosis

Granulomatous drug reactions: vacuolar interface changes, often epidermotrophism of lymphocytes; resolves when drug is stopped
Rheumatoid dermatosis: extensive homogeneous necrobiosis with numerous giant cells and stromal fibrosis
Interstitial granuloma annulare: mid dermal necrobiotic collagen center surrounded by palisading histiocytes, with fibroblasts and lymphocytes; occasional foreign body giant cells, vasculitis, mucin; may need multiple sections to find necrobiotic collagen
Necrotizing granuloma: may be due to infectious microorganism

Additional references

Hum Pathol 2004;35:779 (editorial)

End of Skin-nontumor > Granulomatous but non-infectious disorders > Interstitial granulomatous dermatitis with arthritis

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).