Malignancy-Associated Generalized Granuloma Annulare in a Japanese Patient with Stomach Cancer and Diabetes Mellitus

Case Report

Austin J Dermatolog. 2022; 9(1): 1101.

Malignancy-Associated Generalized Granuloma Annulare in a Japanese Patient with Stomach Cancer and Diabetes Mellitus

Yokoyama K, Ikeda T and Kawakami T*

Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan

*Corresponding author: Tamihiro Kawakami, Division of Dermatology, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyaginoku, Sendai, Miyagi 983-8536, Japan

Received: February 04, 2022; Accepted: February 15, 2022; Published: February 22, 2022

Introduction

Granuloma annulare is a benign granulomatous dermatosis with variable clinical presentation. It is of unknown origin and results in erythematous, brown, or skin-colored annular plaques usually found over boney surfaces on the extremities. The main variants are localized granuloma annulare, subcutaneous granuloma annulare, perforating granuloma annulare, and generalized granuloma annulare. Systemic diseases proposed to have an association with granuloma annulare include diabetes mellitus, dyslipidemia, hypothyroidism, and various malignancies. Cohen [1] coined the term ‘malignancy-associated granuloma annulare’ to describe a form of granuloma annulare that is temporally associated with a malignant process, in which the onset of granuloma annulare coincides with the discovery of a previously unsuspected neoplasm or metastatic disease, and the course of the granuloma annulare also parallels that of the tumor. We present a Japanese patient with malignancy-associated generalized granuloma annulare as the first manifestation of stomach cancer based on diabetes mellitus.

Case Presentation

An 86-year-old man with a history of type II diabetes mellitus visited our hospital with generalized eruptions on his extremities and trunk that had developed over a 4-month period. He had concurrent anemia and shortness of breath. On physical examination, asymptomatic yellow-brown to violaceous papules and plaques measuring from 0.5 to 3 cm were distributed predominantly over his extremities and trunk (Figure 1). Histopathological analysis of a skin lesion showed a granulomatous infiltrate composed of lymphocytes, histiocytes and multinucleated giant cells surrounding degenerated collagen in the middle dermis (Figure 2). Routine laboratory analyses revealed increased levels of glucose (125mg/dL) and HbA1c (6.8%), while lipid and thyroid hormone levels were normal, and evidence of anemia including a depressed Hb count (6.5g/dL). Endoscopic examination revealed the presence of stomach adenocarcinoma. We determined that the onset of granuloma annulare coincided with the appearance of stomach cancer. Topical corticosteroids were ineffective.

Citation: Yokoyama K, Ikeda T and Kawakami T. Malignancy-Associated Generalized Granuloma Annulare in a Japanese Patient with Stomach Cancer and Diabetes Mellitus. Austin J Dermatolog. 2022; 9(1): 1101.