Granuloma anulare giganteum et disseminatum

Granuloma annulare is a relatively common non-infectious disease with unknown aetiology sometimes associated with systemic conditions. It is characterized by a necrobiotic granulomatous inflammation. A rare manifestation of the disease is granuloma annulare giganteum exhibiting as hard plaques with lesions up to 20 centimetres. We report a 44-year old male patient with a granuloma annulare giganteum et disseminatum. Despite topical therapy with glucocorticosteroids and repeated intralaesional steroid-injections further progression was observed. After beginning of treatment with fumaric acid ester (FAE) with the dosage recommended for treatment of psoriasis, a slow amelioration occured. Increasingly the patient reported sickness and diarrhea when the treatment reached four tablets of FAE per day. Finally a hyperthyroidism was confirmed with delay since the complaints initially were related to the treatment with FAE. As consequence by being aware of an increase of diarrhea, a fast loss of weight and tachycardia the development of a hyperthyroidism should be considered.