Colchicine for refractory palisading and neutrophilic granulomatous dermatitis associated with mixed connective tissue disease

We report a 38-year-old woman with mixed connective tissue disease (MCTD), interstitial lung disease, and inflammatory polyarthritis who developed progressively painful, firm papules on her bilateral elbows and dorsal hands. Histopathology confirmed palisaded neutrophilic granulomatous dermatitis (PNGD). Despite treatment with topical and intralesional corticosteroids, azathioprine, hydroxychloroquine, and belimumab over more than 2 years, her cutaneous lesions persisted, causing significant functional impairment. Colchicine was initiated at 0.6 mg daily and titrated to twice daily as tolerated. Following colchicine therapy, she experienced marked clinical improvement, with resolution of pain and near-complete clearance of papules. This case highlights colchicine as a potential therapeutic option for chronic, treatment-refractory PNGD associated with MCTD.