Granuloma possibly induced by palladium after ear piercing.

A case of sarcoidal-type allergic contact granuloma due to palladium is presented. The patient developed papulonodular lesions at the right earlobe after ear piercing, which after 3 to 4 years became more granulomatous and very resistant to treatment. Repeated intralesional injections with corticosteroids produced only a temporary regression of the lesions. Patch testing revealed a strong positive reaction to palladium (and nickel). Biopsy specimens taken from the persistent granulomatous lesion in the nodule at the earlobe, as well as from the site of the positive test reaction to palladium several weeks after patch testing, indicated epithelioid granulomas with some multinucleate histiocytes surrounded by a lymphocytic-histiocytic infiltrate. Similar cases (also with other metals) have been reported in the literature.