A case of palisaded neutrophilic granulomatous dermatitis in rheumatoid arthritis

Palisaded neutrophilic granulomatous dermatitis (PNGD) is an unusual entity that has been described under several different names including, linear subcutaneous bands, interstitial dermatitis with cutaneous cords and arthritis, rheumatoid papules and Churg-Strauss granuloma. The condition is seen in patients with rheumatoid arthritis and other connective tissue diseases. PNGD shows variable clinical manifestations and represents a histologic spectrum, starting with early vasculitic lesions, then palisaded granulomatous lesions and dermal fibrosis with minimal leukocytoclastic debris in the late stage lesions. We report an unusual case of a 49-year old woman with rheumatoid arthritis who presented with multiple acral nodules. The histologic examination revealed palisaded neutrophilic granulomatous dermatitis.