Extraordinary Case ReportGeneralized Necrobiotic Palisading Granulomatous Follicular Eruption A Peculiar Pustular Variant of Perforating Granuloma Annulare or an Individualized Disease?Deza, Gustavo MD*; Vidal, Ainhoa MD*; Gallardo, Fernando MD, PhD*; Iranzo, Pilar MD†; Canal de la Iglesia, Laia MD‡; Pujol, Ramon M. MD, PhD*Author Information *Department of Dermatology, Hospital del Mar Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; †Department of Dermatology, Hospital Clínic, Universitat de Barcelona (UB), Barcelona, Spain; and ‡Department of Dermatology, Hospital General de Mollet, Barcelona, Spain. Correspondence: Gustavo Deza, MD, Department of Dermatology, Hospital del Mar Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Passeig Marítim, 25-29, 08003 Barcelona, Spain (e-mail: firstname.lastname@example.org). The authors declare that they have no conflicts of interest. The American Journal of Dermatopathology: February 2020 - Volume 42 - Issue 2 - p e22-e25 doi: 10.1097/DAD.0000000000001495 Buy Metrics Abstract Herein, we report a case of an adult male patient with a chronic and recurrent papulopustular eruption mainly involving the trunk and lower extremities. A dense superficial perifollicular inflammatory infiltrate with palisading necrobiotic granuloma formation and infundibular perforation was observed at the histological examination, with no granulomatous inflammatory infiltrates in deeper areas. The possibility that this peculiar clinicopathological presentation constitutes a case of generalized perforating granuloma annulare (PGA) or an individualized skin condition is discussed. The observation of a pustular follicular generalized PGA represents an exceedingly rare phenomenon and constitutes an infrequent subtype of PGA that can mimic pustular eruptions secondary to many different etiologies. The clinicopathological features of this rare variant may represent a diagnostic challenge, often requiring multiple biopsies to establish a definite diagnosis. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.