[Granuloma annulare of the photoexposed areas in two liver transplant recipients].
BACKGROUND
We report two cases of generalized granuloma annulare occurring in photoexposed areas in two liver transplant recipients.


METHODS
Case 1 was a 65-year-old man who had undergone liver transplantation in 1992. He was given immunosuppressive and antihypertensive therapy. Within 18 months of transplantation, he developed a confluent rash with maculae on sun-exposed areas (neck opening, nape, arms) and sparing the undershirt area. Clinical examination was normal. Skin biopsy revealed a palissade infiltrate located in the middle and upper derma, suggestive of granuloma annulare, with elastophagocytosis patterns (orcein stain and ultrastructure study). Photoexposure granuloma was diagnosed. Case 2 was a 59-year-old man who had undergone liver tranplantation in 1994. He was given immunosuppressive and antihypertensive therapy and developed within 4 months a dark rash on the neck opening and nape, sparing photoprotected areas. Histopathology revealed granuloma annulare. Elastophagocytosis was disclosed by orcein stain and the ultrastructure study.


CONCLUSIONS
This clinical presentation of granuloma annulare in two liver transplant recipients is unusual. We discuss the clinical and histopathological patterns observed in our two cases and the relationships between granuloma annulare and immunosuppression.
Derancourt
C
C
Service de Dermatologie, CHU, Besançon.
Senser
M
M
Atallah
L
L
Becker
M C
MC
Laurent
R
R
D000368:Aged; D001706:Biopsy; D004547:Elastic Tissue / Q000473:pathology; D016460:Granuloma Annulare / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010587:Phagocytosis; D010787:Photosensitivity Disorders / Q000175:diagnosis* / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology; D012867:Skin / Q000473:pathology