A Case of the Cutaneous Ganulomatous Lesions and Refractory Gastric Ulcer Successfully Treated with Systemic Steroids Applications

Abstract

A case of the cutaneous ganulomatous lesions and refractory gastric ulcer was reported. A 63-year-old woman was suffering from uncurable gastric ulcers although she had been treated with various kinds of anti-gastric ulcer drugs for more than 9 years. The Helicobacter Pylori infection in the ulcer lesions was negative. The patient also noticed the skin lesions on the front side of her lower legs about 1 year before the ulcer treatment was initiated. The skin lesions showed marginally elevated asymptomatic annular erythemas on the legs with the sized of 5cm meter on her left leg and to 15cm diameters on the right. The histology of the biopsied skin specimen revealed noncaseous granuloma formation in the dermis with many Langhans type giant cells infiltrations and asteroid body existence inside the some giant cells. Both the clinical and histological findings strongly suggest necrobiosis lipoidica as the diagnosis of the skin lesions.
Since topical steroid applications to the skin lesions were not successful and she did not have diabets, the systemic treatment with predonisolone was started and proved remarkably effective with a complete lesional remission. In addition, the gastric ulcers were also completely cured in conjunction with the improvement of the skin lesions, although the histology of the gastric ulcer specimens did not note the granuloma formation. From the standpoints of the remarkable steriod efficacy, it should be further disscused whether or not the systemic sarcoidosis would be a possible differential diagnosis for the both skin and gastric lesions.