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