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Paraneoplastic granulomatous dermatitis in a patient with Hodgkin’s disease: a diagnostic pitfall
  1. Mika M. Tabata1,
  2. Roberto A. Novoa2,
  3. Kathryn J. Martires2
  1. 1Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2Department of Dermatology, Stanford University, Stanford, California, USA
  1. Correspondence to Mika M. Tabata, mtabata1{at}


The association of malignant lymphomas with non-necrotic epithelioid granulomas has been reported rarely since 1977. Hodgkin’s disease-associated widespread cutaneous granuloma annulare (GA) has been reported in only eight patients. We report the second case of subcutaneous GA associated with Hodgkin’s disease. A 73-year-old man with Epstein-Barr virus-associated Hodgkin’s lymphoma and paraneoplastic subcutaneous GA, presented 3 months after the diagnosis of malignancy. Examination revealed a large, broad erythematous, indurated, subcutaneous plaque spanning the majority of the left lower back and flank with no associated symptoms. Initial biopsy was suggestive of morphea. Prompted by positron emission tomography (PET) findings of increased fluorodeoxyglucose (FDG) uptake, a second, deeper biopsy was performed, revealing subcutaneous palisaded granulomatous dermatitis. After complete workup, the diagnosis most strongly suggested subcutaneous GA. This case highlights the importance of deep incisional biopsies, the fluorodeoxyglucose - positron emission tomography (FDG-PET) findings in GA and the rare association of GA with Hodgkin’s disease which may signal the presence of malignancy.

  • dermatology
  • oncology
  • skin
  • malignant and benign haematology
  • cancer - see oncology
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  • Contributors MMT assisted with manuscript writing and final editing. RAN assisted with pathology interpretation and final editing. KM assisted with manuscript writing, care of patient, pathology interpretation and final editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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