GRANULOMA-ANNULARE, NODULAR TYPE - A SUBCUTANEOUS PSEUDORHEUMATOID LESION IN CHILDREN

Five cases of patients aged between 2 years 8 months and 5 years 6 mon ths with subcutaneous nodular granuloma annulare are reported, Histolo gically the lesions resembled rheumatoid nodules, consisting of acellu lar central areas surrounded by palisading histiocytes. Complete or pa rtial excisions were done for diagnosis. Initially the granulomata wer e not associated with any symptoms of systemic illness, but one patien t with IgG deficiency developed subsequent polyarthritis. Antistreptol ysin O, antinuclear antibodies and latex fixation test for rheumatoid arthritis were negative except for one patient with additional erythem a nodosum and elevated antistreptolysin level, In the other patients t he laboratory data were uncharacteristic. The clinical course may be c haracterized by spontaneous regression and frequent recurrence. In asy mptomatic patients further treatment is not necessary. Patients with p rogressive disease or elevated inflammatory activity were treated with nonsteroidal antirheumatics. The development of subsequent rheumatoid disease in primarily asymptomatic patients is unlikely, but we recomm end further observation by an experienced pediatrician.