A case of annular elastolytic giant cell granuloma with repeated cycles of remission and relapse

Abstract

A 70-year-old man presented with annular, erythematous lesions on his trunk and limbs. He had been treated with topical steroids for a few years, at another hospital. However, the lesions had persisted for decades. At his first visit to our hospital, he presented with annular, erythematous plaques on the neck, back, and arms. The plaques had slightly elevated borders. Annular elastolytic giant cell granuloma (AEGCG) was diagnosed based on the histological findings of loss of elastic fibers, and formation of a granuloma consisting of histiocytes as well as multinucleated giant cells. The giant cells demonstrated phagocytosis of fragmented elastic fibers. The rash appeared to fade following treatment with tranilast for 7 months, but it relapsed two months later, despite continued treatment with tranilast. In addition, nausea occurred as an adverse effect and tranilast had to be discontinued. Subsequently, the patient was observed without any treatment. Temporary remission of the rash was observed after the excision of a colon polyp and a vertebral compression fracture. However, the rash relapsed yet again and persisted for a long duration. Although several treatment options are available for AEGCG, no definite treatment has been established thus far. We present conservative observation as a viable option in the management of patients with AEGCG.