Palisaded neutrophilic and granulomatous dermatitis associated with ledipasvir/sofosbuvir

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a cutaneous reaction pattern seen in association with systemic diseases and rarely with infections or medications.1 Typical clinical presentation includes tender, erythematous-to-violaceous papules, plaques, or nodules affecting extensor and acral surfaces, most commonly the elbows and hands.1,2 Histopathologic examination of the lesions can vary, and the disease is thought to occur along a continuum, with early lesions histologically resembling leukocytoclastic vasculitis with dense neutrophilic infiltration and more established lesions consisting of palisaded histiocytes and small granulomas with trapping of collagen and neutrophilic debris.