Spectrum of Granulomatous Skin Lesions- A Dermato-Pathological Perspective

Granulomatous dermal lesions pose a diagnostic challenge, since several causes can produce an identical histologic picture and, conversely, a single cause may produce varied histologic pattern. The aim of this study is to analyze the spectrum of various etiologies involved in granulomatous skin diseases and their clinicopathological correlation. Cases of granulomatous lesions reported over last one year on histopathological and cytological examination were reviewed along with special stains. A total of 20 cases of different etiologies were taken for study including infectious and non-infectious underlying causes. Out of the 20 dermal granulomatous lesions studied, 12 cases (60.0%) were bacterial, 1 case (5%) each of fungal and associated with malignancy and 6 cases (30%) due to non-infectious etiology like granuloma annulare and foreign body associated were recorded. Amongst the bacterial granulomatous lesions, predominance of Mycobacterium leprae was seen, 6 cases (40%). The varied presentation of Hansen’s disease in our study included 4 cases (20%) of tuberculoid leprosy and 2 cases (10%) each of lepromatous leprosy and borderline tuberculoid leprosy. Three cases (15%) of cutaneous tuberculosis seen in our study and were typified as lupus vulgaris, 2 cases (10%) and a single case (5%) of tuberculosa verrucosa cutis. One case, (5%) of Klebsiella rhinoscleromatis was also seen. Skin biopsies help in arriving at a conclusive diagnosis, if aided by a proper clinical history and examination and assisted by special stains, culture of organisms, PCR and immunoflourescence.