Chronic Treatment-Resistant Annular Rash: A Case of Neutrophilic Figurate Erythema

TL;DR

A rare skin condition called Neutrophilic Figurate Erythema was misdiagnosed for years and required anti-neutrophil treatment for resolution.

Contribution

This case highlights the diagnostic challenges and treatment approach for the rare condition Neutrophilic Figurate Erythema.

Findings

The patient had a chronic, treatment-resistant rash resembling Erythema Annulare Centrifugum.

Histology showed neutrophil and eosinophil infiltration without vasculitis or infection.

NFE may require anti-neutrophil therapy for complete resolution.

Abstract

Neutrophilic figurate erythema (NFE) is a rarely reported figurate erythema that clinically presents similarly to erythema annulare centrifugum (EAC) with neutrophil-predominant perivascular and interstitial infiltrate in the dermis on histopathology. We present the case of a 32-year-old active-duty military male who presented with a chronic treatment-resistant skin rash. The rash began on his thighs five years previously and was treated with topical and oral antifungals repeatedly without improvement. The patient was deployed overseas during the rash onset, but the rash persisted upon his return stateside. No triggers were identified. His persistent skin eruption consisted of erythematous polycyclic annular plaques with a "trailing edge" scale. Histologic examination revealed perivascular neutrophils and perivascular and interstitial eosinophils without signs of vasculitis or infection. With only 15 reported cases, it can be difficult to recognize leading to long delays in diagnosis and treatment. Despite having a clinical course similar to EAC, NFE may require anti-neutrophil therapy to resolve completely.

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