Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Case Letter
doi: 10.4103/0378-6323.173594
PMID: 26765132

Erythema gyratum repens associated with cryptogenic organizing pneumonia

Dominik Samotij, Justyna Szczech, Magdalena Bencal-Kusinska, Adam Reich
 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland

Correspondence Address:
Adam Reich
Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, 50 368 Wroclaw
How to cite this article:
Samotij D, Szczech J, Bencal-Kusinska M, Reich A. Erythema gyratum repens associated with cryptogenic organizing pneumonia. Indian J Dermatol Venereol Leprol 2016;82:212-213
Copyright: (C)2016 Indian Journal of Dermatology, Venereology, and Leprology


Erythema gyratum repens is a figurate erythema with a characteristic wood grain pattern and rapid peripheral spread. Here, we report a case of erythema gyratum repens occurring in a patient with cryptogenic organizing pneumonia.

A 54-year-old male was admitted due to peculiar figurate erythemas mainly located on the lower legs. The patient had an 18-month history of cryptogenic organizing pneumonia complicated by pulmonary hypertension. Cryptogenic organizing pneumonia was diagnosed based on chest X-ray, computed tomography (showing dispersed stromal fibrosis with bronchiectasis [Figure - 1] and mediastinal lymph node enlargement) and lung biopsy.

Figure 1: Computed tomography of the chest showing dispersed stromal fibrosis of the lungs with bronchiectasis

Seven months after onset of cryptogenic organizing pneumonia, the patient developed erythematous raised skin lesions initially misdiagnosed as urticarial wheals. He underwent treatment with antihistamines for 5 months without improvement. New skin lesions continued to develop on an intermittent basis, were painful and accompanied by fever, malaise and deterioration of respiratory function. The patient was admitted for investigations and management. At the time of admission, he had non-pruritic, pale red, slightly elevated, polycyclic and concentric mildly scaly plaques. The skin lesion resembled wood grains and showed rapid peripheral progression [Figure - 2]. Physical examination, abdominal and pelvic sonography and computed tomography, upper gastrointestinal endoscopy and colonoscopy revealed no abnormalities. On complete blood count, the patient had microcytic hypochromic iron deficiency anemia with hemoglobin of 9.9 g/dL, serum iron level 4.0 μmol/L; (normal range: 11.6-31.2 μmol/L). Bone marrow aspirate did not reveal any abnormalities. However, hypocomplementemia (low C3 and C4) and marked elevation of serum inflammatory biomarkers (C-reactive protein level: 150.4 mg/L, erythrocyte sedimentation rate: 54 mm/h, ferritin level: 920 μg/L, and alpha-1-acid glycoprotein: 2.99 mg/ml [normal range: 0.6-1.2]) was found. Liver function tests were within the normal limits except a moderately raised serum gamma glutamyl transpeptidase level of 131 U/L. Urine examination showed marked proteinuria (>0.5 g/dL) although no kidney biopsy was performed to evaluate the reason for proteinuria. Antinuclear antibodies and antineutrophil cytoplasmic antibodies were negative in the serum. Histological examination of a skin biopsy showed an atrophic epidermis with dermal perivascular mononuclear cell infiltration [Figure - 3]. The patient was continued on oral prednisone 20 mg/day for cryptogenic organizing pneumonia. As the patient′s clinical condition progressively deteriorated, he was re-investigated but no other underlying disease was found. The patient was then started on pulsed cyclophosphamide therapy (500 mg i.v. each month for 7 months) leading to marked improvement of respiratory function, proteinuria and a gradual improvement of skin changes which resolved within 6 months. The patient has been under observation for the last 3 years with no relapse or signs of any malignancy.

Figure 2: Concentric, polycyclic plaques of erythema gyratum repens
Figure 3: Mild hyperkeratosis and mixed perivascular inflammatory infiltrate in the upper dermis (H and E original magnification, ×100)

Since its first description erythema gyratum repens has been considered to be a paraneoplastic dermatosis. [1] However, in about 10-15% of patients it may accompany other diseases such as connective tissue diseases, infections and other conditions. Almost one-third of all non-paraneoplastic erythema gyratum repens cases have been considered idiopathic. [1],[2],[3]

Erythema gyratum repens is considered as an immunologically driven skin disease, however, its etiology still remains poorly understood. Currently, there are three suggested hypotheses regarding its pathogenesis: (1) cross-reacting tumor antigens which causes an inflammatory skin disorder, (2) transformation of normal skin proteins by tumor thus making them antigenic, (3) deposition of immune complexes with tumor antigens at the basement membrane zone and induction of inflammation. [4],[5] Despite a distinctive clinical morphology, skin lesions of erythema gyratum repens have non-specific histologic findings with acanthosis, mild hyperkeratosis, focal parakeratosis and epidermal spongiosis with superficial mononuclear, lymphohistiocytic perivascular inflammatory infiltrate in the dermis. [4],[5] Direct immunofluorescence of lesional skin may show IgG and C3 deposits along the basement membrane zone.

In our patient, we were unable to identify any of the conditions previously described to coexist with erythema gyratum repens. The exacerbation of skin lesions temporally correlated with periods of high activity of the lung disease. Based on this observation, we concluded that erythema gyratum repens in our patient was related to underlying cryptogenic organizing pneumonia; we were unable to find previous reports of this association.

Interestingly, the skin lesions in our patient were quite painful, a feature that is not usually reported in erythema gyratum repens.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Rongioletti F, Fausti V, Parodi A. Erythema gyratum repens is not an obligate paraneoplastic disease: A systematic review of the literature and personal experience. J Eur Acad Dermatol Venereol 2014;28:112-5.
[Google Scholar]
Barber PV, Doyle L, Vickers DM, Hubbard H. Erythema gyratum repens with pulmonary tuberculosis. Br J Dermatol 1978;98:465-8.
[Google Scholar]
Endo Y, Fujisawa A, Tanioka M, Miyachi Y. Erythema gyratum repens preceding the onset of rheumatoid arthritis. Eur J Dermatol 2013;23:399-400.
[Google Scholar]
Eubanks LE, McBurney E, Reed R. Erythema gyratum repens. Am J Med Sci 2001;321:302-5.
[Google Scholar]
Stone SP, Buescher LS. Life-threatening paraneoplastic cutaneous syndromes. Clin Dermatol 2005;23:301-6.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections