* Dermatology Department, „Carol Davila” Central University Emergency Military Hospital, Bucharest

1. Generalized annular granuloma after initiation of therapy with beta blockers for glaucoma-case report- • * Dermatology Department, „Carol Davila” Central University Emergency Military Hospital, Bucharest • ** Dermatopathology Department, „Domina-Sana” Medical Center, Bucharest Andreea Stancu* , Aurel Doru Chirita**, Irina Margaritescu**

2. Introduction Granuloma annulare (GA) is a benign inflammatory dermatosis Granuloma annulare is a relatively common disease that occurs in all age groups Characterized: clinically by dermal papules and annular plaques histologically by foci of degenerative collagen associated with palisaded granulomatous inflammation

3. Clinical case • We report a case of a 59 years-old women who presented with a 3 months history of pruritic papules, patches and well circumscribed plaques • The lesions appeared first on the abdomen and anterior thorax and in a few days they became generalized

4. Clinical case • Disseminated erythematous papules, patches, plaques

5. Granulomatous nodular dermatitis with superficial and deep perivascular infiltrate of lymphocytes and histiocytes arranged in a palisade around a locus that consists mostly of mucin, and degenerated collagen bundlles

6. Histiocytes in a palisade and scattered interstitially • Degeneration of collagen • Deposits of mucin

7. Interstitial lymphocytes and epithelioid histiocytes

8. Discussion • Granuloma annulare can present with two different histologic patterns: • Palisaded • Interstitial • Our case have findings of both palisaded and interstitial patterns

9. Conclusions • Although the aetiology and pathogenesis of granuloma annulare are unclear, it appears likely that it represents a reaction pattern to a variety of triggering factors • Because lesions started after the initiation of the B-blocker treatment we suspected a drug reaction • Treatment: • discontinuation of culprit drug • Corticosteroids • PUVA-therapy