Abstract

Granulomatous skin eruptions have been described in association with both Hodgkins and Non-Hodgkins variants of T-cell lymphoma. These eruptions have been less commonly described in association with B-cell neoplasms. Herein we report a case of a palisaded granuloma annulare-like eruption with prominent lymphoid aggregates, consistent with the patient’s known diagnosis of small lymphocytic lymphoma (SLL). A 55 year-old male with a history of SLL presented to the dermatology clinic with erythematous annular plaques with raised borders and central clearing on the bilateral forearms. A punch biopsy was obtained, revealing palisaded granulomatous dermatitis with central necrobiosis and elastophagocytosis. Nodular aggregates of small, uniform lymphocytes were present in the dermis adjacent to the granulomas with positive staining for PAX5, CD5, and CD23. These findings were suggestive of involvement by the patient’s known SLL. Granulomatous dermatitis has been rarely described in association with B-cell neoplasms. We present a case highlighting the co-existence of nodular lymphoid aggregates and a palisaded granulomatous dermatitis as a cutaneous representation of the patient’s underlying diagnosis of SLL. While it is unclear from the literature whether this represents a primary or secondary reactive infiltrate, recognition of this association is important to raise suspicion of a neoplastic B cell infiltrate in association with a granuloma-annulare like granulomatous dermatitis.