DISSEMINATED GRANULOMA ANNULARE ASSOCIATED WITH NECROBIOSIS LIPOIDICA – CASE STUDY

Granuloma annulare and necrobiosis lipoidica are granulomatous diseases with an unclear etiology. The presence of both pathologies in the same patient is quite rarely reported. Clinical case: We present a 75-year-old patient, from urban environment, with disseminated granuloma annulare and necrobiosis lipoidica, and we aim to point out the clinical progress as well as the histopathological and therapeutic aspects of both diseases. After paraclinical investigations, the patient was also diagnosed with diabetes mellitus. The recommended treatment was Ofloxacin 400 mg/day, Doxycycline100 mg/day and Rifampicin 150 mg (2 cps. every 12 h) for three consecutive days/month over a period of four months, and 0.1% Tacrolimus (one application/day in the evening). The 4-month evolution since the beginning of the treatment has been favorable only for the granuloma annulare lesions. Discussions: Granuloma annulare and necrobiosis lipoidica can be associated with diabetes mellitus and more frequently affect women. The concurrent occurrence of both diseases has been rarely reported, only 11 cases presenting this association. There is no standard treatment for the two diseases. The favorable result of the therapy using cyclins is due to the anti-infectious, anti-inflammatory and immunomodulatory actions of these agents. Conclusion: The association of the two diseases is very rare and we require further investigations to elucidate common pathogenic mechanisms and establish optimal therapy.