Palisaded neutrophilic and granulomatous dermatitis presenting as bilateral dorsal hand nodules: a clinicopathological case report

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a rare reactive dermatosis associated with systemic diseases, including autoimmune disorders, infections, and hematological malignancies. Its variable clinical presentation and histopathological features necessitate careful clinicopathological correlation. We report a case of multiple painful erythematous nodules over the dorsal aspects of both hands, persisting for approximately one year. Histopathological examination of a punch biopsy from the right hand revealed a dense dermal inflammatory infiltrate predominantly comprising of neutrophils with histiocytes, lymphocytes, and scattered eosinophils. Areas of collagen degeneration with abundant leukocytoclastic nuclear debris and occasional multinucleated giant cells were also observed. These findings supported the diagnosis of PNGD. This case highlights the characteristic histopathological features of PNGD at an uncommon acral site and emphasizes the importance of considering it in the differential diagnosis of granulomatous dermatoses. Recognition is essential to prompt evaluation for associated systemic disease.