Generalized Granuloma Annulare

GENERALIZED GRANULOMA ANNULARE

はじめに

　本邦における環状肉芽腫の報告は，昭和6年の第1例^1）以来123例に達したが^2），最近稀有とされる本症の汎発型が相ついで報告され，とくに昭和41年以降わずか3年余のうちに9例^3〜10）を数え，10例となつた。そこで，われわれの教室における症例を記載するとともに，これら症例につき2,3の考察を加えたい。

A 56-year-old man found a pea-sized, annular lesion on the flexor aspect of the left forearm about 7 years ago, which enlarged gradually in spite of the topical application of various oint-ments. His familiar history had nothing contributive. He had chronic hepatitis which was under the medical care.

In November 1967, the similar lesions disseminated symmetrically almost over the entire body surface except the face, neck, scalp, and thigh. They were itchy temporalily.

The lesions consisted of red papules, 3 mm in diameter, or annular plaques with elevated borders, about 20 cm in diameter. The papules were infiltrated, and had a tendency to arrange annularly. On the hypogastrium there was a slightly depressed erythema. On the extensor surface of the fingers there were dome-shaped, up to 5 mm in diameter, cartilage-hard nodules.

Laboratory examination revealed a mildly positive tuberculin reaction, slight increase in β-, and γ globulin, disturbance of liver function, and positive STS, while there were no abnormality in the blood sugar level, urine, nor faeces.

Histologic specimen showed localized degeneration of collagenous fibers surrounded by lympho-histiocytic granulomatous infiltration.

The former contained the substance stained positive by the alcian blue and mucicarmin.

Treatment with local injection of glycocorticoid and application of ointment containing high dosis of glycocorticoid were successful.

The lesions became worse by Bicillin-V₂ for the treatment of syphilis, Kowever they were improved. by a high fever due to an infection The mechanisms of these phenomena could not he clarified.