Atypical Interstitial Granuloma Annulare: A Possible Uncommon Systemic Manifestation of Atrial Myxomas

A 73-year-old man presented with lower back pain and bilateral palmar lesions. Urine culture grew Streptococcus agalactiae and C-reactive protein was raised. He was treated with antibiotics for urinary tract infection with suspected pyelonephritis. An echocardiogram ordered to look for infective endocarditis was suggestive of a left atrial myxoma. He subsequently developed an acute right common iliac artery embolus, which resolved with conservative management. He underwent a successful open-heart left atrial mass and appendage resection, with histopathology confirming atrial myxoma. Skin biopsies of the lesions ten weeks post onset showed granuloma annulare of the palms.