Deep Granuloma Annulare in Adults

Subcutaneous nodules with the histopathologic features of rheumatoid nodules can occur in both rheumatic and nonrheumatic diseases. When there is no evidence of systemic disease, they often are classified as deep granuloma annulare. While there are numerous reports of such nodules occurring in children without systemic disease, there are few reports of similarly affected adults. Two adults are described with multiple subcutaneous nodules that were overlying joints and were histologically similar to rheumatoid nodules. Neither patient had other clinical or laboratory manifestations of rheumatic disease. These cases most likely represent an adult form of deep granuloma annulare. The wide clinical spectrum in which similar nodules can occur and their pathogenesis is discussed.