Subcutaneous Granuloma Annulare in a Middle-Aged Patient: A Case Report

Abstract

Subcutaneous granuloma annulare (SGA) is a rare, benign variant of granuloma annulare, typically seen in children, which presents as asymptomatic subcutaneous nodules with normal overlying skin. The etiology remains unclear despite associations with systemic disease such as diabetes mellitus. Clinicopathologic correlation is crucial to accurate diagnosis. In this report, we present a case of a 53-year-old female patient with tender, bilateral subcutaneous nodules on her elbows. Punch biopsy confirmed the diagnosis of granuloma annulare. The primary management for her condition at the time was focused on observation and conservative care. However, secondary management with intralesional injection of triamcinolone was utilized when her lesions recurred after a window of resolution. Our case highlights an interesting manifestation of granuloma annulare and demonstrates the importance of both clinical and histological evaluation in distinguishing between similar presenting differential diagnoses. Successful treatment is heavily dependent on accurate diagnosis and patients should be monitored for complete resolution.

Keywords: case report; deep granuloma annulare; necrobiosis lipoidica; palisading granuloma; rheumatoid nodule.

Figure 1. Clinical photograph revealing tender, dermal nodules, and plaques on the right elbow.

Figure 2. Histopathology obtained from biopsy of the right elbow demonstrating palisading histiocytes surrounding central necrobiotic material, hyaluronic acid, and mucin deposits (H&E, original magnification x 10x). Palisading granulomas surrounding central necrobiotic material are indicated by black arrows and mucin deposits noted by black stars.

H&E: hematoxylin and eosin

Figure 3. Clinical photograph revealing tender, dermal nodules, and plaques on the right elbow one month after initial presentation in the clinic.