E. Ellis , G. Marshman
Necrobiotic xanthogranuloma (NXG) is a chronic granulomatous condition ﬁrst described by Kossard and Winkelmann in 1980. The characteristic cutaneous lesion is a violaceous or yellowish papule, nodule, or plaque a few millimetres to 25 centremetres in size which may be cosmetically disﬁguring. To date, there have been 5 reports of NXG occurring in scars (Koch). Diagnosis relies on characteristic histological features which include granulomas composed of foreign body and Touton giant cells admixed with foci of collagen necrobiosis (Spicknell). Cholesterol clefts within the necrobiosis assist in diagnosis but are not essential. Extra-cutaneous granulomatous disease has been described (Fortson, umbert, hunter, winkelmann, westermann, novak). Liver involvement has been reported in three cases, however histological changes were reactive. To date, there are no known cases of primary liver disease. We present the ﬁrst known case of NXG with primary granulomatous disease occurring in the liver. Additionally, this is the 6th case of NXG occurring in scars.