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. Case reports. Case 1 was a 65-year-old man who had undergone liver transpla ntation in 1992 He was given immunosuppressive and antihypertensive therapy . Within 18 months of transplantation, he developed a confluent rash with m aculae on sun-exposed areas (neck opening, nape, arms) and sparing the unde rshirt area. Clinical examination was normal. Skin biopsy revealed a paliss ade infiltrate located in the middle and upper derma, suggestive of granulo ma annulare, with elastophagocytosis patterns (orcein stain and ultrastruct ure 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 photoprot ected areas. Histopathology revealed granuloma annulare. Elastophagocytosis was disclosed by orcein stain and the ultrastructure study. Discussion. This clinical presentation of granuloma annulare in two liver t ransplant recipients is unusual. We discuss the clinical and histopathologi cal patterns observed in our two cases and the relationships between granul oma annulare and immunosuppression.