Diagnostic Considerations

Consider the following:

Allergic bronchopulmonary aspergillosis (bronchocentric granulomatosis)
Cutaneous lymphoma
Eosinophilic pneumonia
Leukocytoclastic vasculitis
Loeffler syndrome
Lymphomatoid granulomatosis
Microscopic polyangiitis
Polyarteritis nodosa
Rheumatoid arthritis
Dirofilarial nodules

Differential Diagnoses

Eosinophilic pneumonia
Granulomatosis with Polyangiitis (GPA, formerly Wegener Granulomatosis)
IgA Vasculitis (Henoch-Schonlein Purpura)
Hypereosinophilic Syndrome
Microscopic Polyangiitis

Workup

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Media Gallery

Granuloma with a central core of eosinophilic debris surrounded by a peripheral palisade of epithelioid histiocytes and eosinophils.
Bilateral papules and nodules with central necrosis.
Magnified view of papules and nodules with central necrosis.
Distal digital purpuric papule.

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Author

Claudia Hernandez, MD, FAAD Associate Professor, Director of Dermatological and Clinical Studies, Department of Dermatology, University of Illinois at Chicago College of Medicine; Attending Physician, University of Illinois at Chicago Hospital

Claudia Hernandez, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Association for Cancer Research, Association of Professors of Dermatology, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Jacek C Szepietowski, MD, PhD Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Paula Vogel, MD, and Daniel Schissel, MD, to the development and writing of this article.