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Noiles K, Beleznay K, Crawford RI, Au S. Sarcoidosis Can Present with Necrotizing Granulomas Histologically: Two Cases of Ulcerated Sarcoidosis and Review of the Literature. J Cutan Med Surg 2013; 17:377-83. [DOI: 10.2310/7750.2013.13035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Sarcoidosis is a systemic inflammatory disorder with cutaneous involvement present in 25% of cases. The presence of naked granulomas histologically is the hallmark of sarcoidosis. The presence of necrotizing granulomas is highly suggestive of other granulomatous conditions and leads the clinician to pursue other diagnoses, such as infectious causes. Objectives: We describe two cases of sarcoidosis in which necrotizing granulomas were present on biopsy. Both patients had ulcerated cutaneous lesions of sarcoidosis. In one case, the presence of these atypical histologic features led to a delay in diagnosis of almost 10 years. We review the various histopathologic findings associated with cutaneous sarcoidosis and discuss a potential connection between ulcerated sarcoidosis and atypical histologic findings. Conclusion: When atypical histopathologic features are present, the differential diagnosis of sarcoidosis should not be excluded.
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Affiliation(s)
- Kristin Noiles
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - Katie Beleznay
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - Richard I. Crawford
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - Sheila Au
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
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52
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Lamb RC, Paul M, Dawn G, Drummond A. A 67-year-old woman with resolving atrophic patches. Clin Exp Dermatol 2013; 39:105-7. [PMID: 24117538 DOI: 10.1111/ced.12205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/26/2022]
Affiliation(s)
- R C Lamb
- Alan Lyell Centre for Dermatology, Southern General Hospital, Glasgow, UK
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53
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Rosenhammer B, Bach B, Zoubaa S, Fleck M. Morpheaartige Hautmanifestation einer Sarkoidose. Z Rheumatol 2013; 72:1005-1007. [PMID: 24122171 DOI: 10.1007/s00393-013-1278-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sarcoidosis is an idiopathic systemic disease, which is characterized by the presence of non-caseating granulomas in the affected organs. Cutaneous manifestations are frequently the first clue to the diagnosis; however, the clinical picture of the lesions is heterogenous. Here we report on a 66-year-old woman with localized indurations of the skin on both forearms that were diagnosed as a rare morphea-like skin involvement of a systemic sarcoidosis.
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Affiliation(s)
- B Rosenhammer
- Klinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland,
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Abstract
Sarcoidosis is classified as an acquired systemic granulomatous disease. Because of the fact that sarcoidosis affects multiple tissues and organs, it is characterized by many potential signs and symptoms, as well as by the presence of non-caseating granulomas in the organs involved. Although oral sarcoidosis is relatively rare, it may however, present in the oral cavity. This report presents a rare case of sarcoidosis with the initial presenting symptom as severe generalized gingival enlargement. The gingival enlargement was treated by gingivectomy. After histopathological examination of gingival biopsy and certain special investigations, a diagnosis of sarcoidosis was made.
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Affiliation(s)
| | - Mala Baburaj Dixit
- Department of Periodontics, Nair Hospital Dental College, Mumbai, Maharashtra, India
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Verrucous cutaneous sarcoidosis: case report and review of this unusual variant of cutaneous sarcoidosis. Am J Dermatopathol 2013; 35:273-6. [PMID: 23344007 DOI: 10.1097/dad.0b013e318262ed4c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sarcoidosis is a multisystem disorder of unknown origin, characterized by the accumulation of lymphocytes and mononuclear histiocytes inducing the formation of noncaseating "naked" epithelioid granulomas. The lungs, lymphatic system, and skin are most often affected, but sarcoidosis may affect any organ. Cutaneous involvement of sarcoidosis is often the sentinel sign of the disease, with the skin sometimes being exclusively affected. We present a case of a 54-year-old African American woman with long-standing history of pulmonary sarcoidosis that presented with multiple verrucous cutaneous lesions on the upper and lower extremities mimicking carcinoma. The initial cutaneous biopsy was superficial in nature, and the pathologist raised the consideration of a possible keratoacanthoma. A deeper skin shave biopsy was performed, and the histopathology showed verrucous pseudoepitheliomatous epidermal hyperplasia with scattered noncaseating granulomas in the superficial dermis. Stains (acid-fast bacillus, Periodic acid-Schiff, and Gomori-Grocott methenamine silver stains) were negative for microorganisms. Given the clinical setting and histomorphology of the cutaneous lesions, the diagnosis of verrucous sarcoidosis was rendered. Verrucous sarcoidosis is a rare cutaneous manifestation of sarcoidosis that could be easily misdiagnosed if it is not appropriately biopsied. This hinders the precise evaluation of the histological specimen, overall clinical picture, and administration of appropriate therapy.
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Affiliation(s)
- Mark D. Hoffman
- Department of Dermatology; Rush University Medical Center; Chicago; Illinois
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58
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Hayakawa J, Mizukawa Y, Kurata M, Shiohara T. A syringotropic variant of cutaneous sarcoidosis: Presentation of 3 cases exhibiting defective sweating responses. J Am Acad Dermatol 2013; 68:1016-21. [DOI: 10.1016/j.jaad.2012.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 10/30/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
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Uterine sarcoidosis: a rare extrapulmonary site of sarcoidosis. Case Rep Rheumatol 2013; 2013:706738. [PMID: 23762732 PMCID: PMC3671678 DOI: 10.1155/2013/706738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/22/2013] [Indexed: 11/21/2022] Open
Abstract
Sarcoidosis is a multisystem disease which is most commonly manifested in the pulmonary system. However, extrapulmonary manifestations have also been frequently reported. Isolated occurrence of sarcoidosis in the genital system is rare and poses a diagnostic and therapeutic dilemma. Uterine sarcoidosis can present with cervical erosions, endometrial polypoid lesions, and recurrent serometra. In majority of cases, it is diagnosed by endometrial curettage, but it has also been detected by examination of hysterectomy, polypectomy, and autopsy specimens. Nonnecrotizing granulomas are the characteristic pathologic finding of sarcoidosis. However, many infectious and noninfectious etiologies including certain neoplasms can produce similar granulomatous reactions in the female genital tract. These conditions affect the female genital tract more commonly than sarcoidosis, and therefore it is important to rule out these conditions first before making a diagnosis of sarcoidosis. Treatment of sarcoidosis is different from treating these other conditions and the most commonly used systemic or local corticosteroids can be hazardous if the underlying cause is infection. In this case report, the clinical presentation, histopathology, clinical course, and treatment of a patient with isolated uterine sarcoidosis are described, and a brief literature review of sarcoidosis of the female genital tract is provided.
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60
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Yanardag H, Tetikkurt C, Bilir M, Demirci S, Iscimen A. Diagnosis of cutaneous sarcoidosis; clinical and the prognostic significance of skin lesions. Multidiscip Respir Med 2013; 8:26. [PMID: 23521826 PMCID: PMC3614473 DOI: 10.1186/2049-6958-8-26] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/15/2013] [Indexed: 11/23/2022] Open
Abstract
Background Sarcoidosis is a systemic disease characterized by the formation of noncaseating granulomas in various tissues. Cutaneous involvement occurs in 20 to 35 percent of the patients and may be the initial manifestation of the disease. Our study was performed to discriminate the clinical, laboratory, and prognostic differences between patients with specific and nonspecific cutaneous involvement. The second aim was to asses the diagnostic usefulness of punch biopsy in sarcoidosis. Methods The clinical, laboratory, pathological features, and skin biopsy results of 120 patients with cutaneous sarcoidosis were evaluated. The patients fulfilled clinical, radiologic or both features of sarcoidosis supported by the histopathologic evidence of noncaseating granulomas. Skin involvement was the initial finding in 30% of the patients. Erythema nodosum and lupus pernio were the most common skin lesions. Almost all of the patients with LP were either stage 0 or 1. Respiratory symptoms occurred in 72.2% of the patients with specific skin involvement. BronchoalveolarLavage (BAL) lymphocytosis, high ratio of CD4/CD8 and elevated serum Angiotensin Converting Enzyme (ACE) were more frequent in patients with specific cutaneous lesions. The frequency of progressive disease was significantly higher in this group. Punch skin biopsy was diagnostic in 81.6% of the patients with a complication rate of 4%. Conclusions Specific cutaneous lesions along with BAL lymphocytosis, high CD4/CD8 ratio and elevated serum ACE levels may be predictors of progressive disease in sarcoidosis. Punch biopsy is a simple technique with a high diagnostic yield and a low complication rate for cutaneous sarcoidosis.
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Affiliation(s)
- Halil Yanardag
- Department of Pulmonary Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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Al-Azri ARS, Logan RM, Goss AN. Oral Lesion as the first Clinical Presentation in Sarcoidosis: A Case Report. Oman Med J 2012; 27:243-5. [PMID: 22811777 DOI: 10.5001/omj.2012.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/30/2012] [Indexed: 12/12/2022] Open
Abstract
Sarcoidosis is a common multi-system disease characterized histolopathologically by the formation of non-caseating granulomas in the affected tissues. The oral involvement of sarcoidosis is relatively rare with less than 70 reported cases in literature while an oral lesion as the initial presenting sign is even less common. Oral lesions of sarcoidosis may mimic the lesions of other serious systemic diseases including Crohn's disease and tuberculosis as well as lesions localized to the orofacial region such as orofacial granulomatosis. This report presents a case of non-progressive sarcoidosis where the initial presenting symptom was a lesion in the buccal vestibule attached to the gingivae. A brief review of the pathology and clinical features is also presented.
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Nasal sarcoidosis: a cause for a medical rhinoplasty? The Journal of Laryngology & Otology 2012; 126:1073-6. [PMID: 22784795 DOI: 10.1017/s0022215112001363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We report the use of triamcinolone injections to correct severe nasal deformity due to sarcoidosis, as an alternative to formal surgical rhinoplasty. CASE REPORT A 30-year-old woman with a long-standing history of sarcoidosis presented to a tertiary referral rhinology clinic complaining of breathing difficulty and nasal deformity. Flexible nasoendoscopy revealed red nasal plaques typical of nasal sarcoidosis, together with significant widening of the nasal bridge. Triamcinolone, a long-acting corticosteroid, was injected both intralesionally and subcutaneously over the nasal dorsum, at zero, three and eight months, resulting in long-lasting improvement of the nasal shape. CONCLUSION Sarcoidosis is a non-caseating, granulomatous, epithelioid inflammation. Otorhinolaryngological manifestations occur in approximately 10 per cent of patients; however, there is little published experience of nasal reconstruction in such patients. We describe a quick, simple and relatively cost-effective technique, with little or no co-morbidity, with which to improve the aesthetic and symptomatic outcomes of nasal sarcoidosis.
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63
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Sarcoidosis: a comprehensive review and update for the dermatologist: part I. Cutaneous disease. J Am Acad Dermatol 2012; 66:699.e1-18; quiz 717-8. [PMID: 22507585 DOI: 10.1016/j.jaad.2011.11.965] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 11/14/2011] [Accepted: 11/17/2011] [Indexed: 11/23/2022]
Abstract
Sarcoidosis is a common systemic, noncaseating granulomatous disease of unknown etiology. The development of sarcoidosis has been associated with a number of environmental factors and genes. Cutaneous sarcoidosis, the "great imitator," can baffle clinicians because of its diverse manifestations and its ability to resemble both common and rare cutaneous diseases. Depending on the type, location, and distribution of the lesions, treatment can prevent functional impairment, symptomatic distress, scarring, and disfigurement. Numerous therapeutic options are available for the treatment of cutaneous sarcoidosis, but there are few well designed trials to guide practitioners on evidence-based, best practice management. In part I, we review the current knowledge and advances in the epidemiology, etiology, pathogenesis, and genetics of sarcoidosis, discuss the heterogeneous manifestations of cutaneous sarcoidosis, and provide a guide for treatment of cutaneous sarcoidosis.
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64
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Mañá J, Marcoval J. Skin manifestations of sarcoidosis. Presse Med 2012; 41:e355-74. [DOI: 10.1016/j.lpm.2012.02.046] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 01/24/2023] Open
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65
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[Cutaneous and pulmonary sarcoidosis. Successful therapy with fumaric acid esters]. Hautarzt 2012; 63:808-11. [PMID: 22552842 DOI: 10.1007/s00105-012-2386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A 43-year-old man with cutaneous and pulmonary sarcoidosis was treated with fumaric acid esters (Fumaderm®) for 11 months because of the cutaneous lesions. During the treatment the cutaneous lesions and pulmonary changes vanished completely. In addition, serum angiotensin converting enzyme (ACE) levels normalized after end of therapy. This case report is one of a few examples of the successful treatment of cutaneous and pulmonary sarcoidosis with fumaric acid esters (Fumaderm®).
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66
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Haimovic A, Sanchez M, Judson MA, Prystowsky S. Sarcoidosis: A comprehensive review and update for the dermatologist. J Am Acad Dermatol 2012; 66:719.e1-10; quiz 729-30. [DOI: 10.1016/j.jaad.2012.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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67
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Tchernev G, Ananiev J, Cardoso JC, Wollina U, Verma SB, Patterson JW, Dourmishev LA, Tronnier M, Okamoto H, Mizuno K, Kanazawa N, Gulubova M, Manolova I, Salaro C. Sarcoidosis and molecular mimicry--important etiopathogenetic aspects: current state and future directions. Wien Klin Wochenschr 2012; 124:227-38. [PMID: 22527817 DOI: 10.1007/s00508-012-0154-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/21/2012] [Indexed: 01/19/2023]
Abstract
Sarcoidosis is a disease of uncertainty in terms of its cause, presentation, and clinical course. The disease has a worldwide distribution and affects all ages, races, and both sex. Sarcoidosis of the skin may have an extremely heterogeneous clinical presentation, so that the definitions of 'great imitator' and 'clinical chameleon' have long been used. The factors that influence clinical picture and severity of the disease are probably linked to the etiopathogenesis of sarcoidosis, which continues to be shrouded in mystery. The current state of the art on the pathogenesis of sarcoidosis is that it is an immunological response in a genetically susceptible individual to an as-yet undefined antigenic stimulus. How exposure occurs in genetically predisposed patients is not completely clear, but the most likely explanation is that these agents or antigens are either inhaled into the lungs or enter through contact with the skin, as these are the common target organs that are constantly in contact with the environment. An autoimmune etiology of sarcoidosis could possibly occur through a process of molecular mimicry of infectious or other environmental antigens to host antigens. This could lead to a cross-mediated immune response and induction of autoimmune disease. This molecular mimicry may probably be responsible for the heterogeneous clinical presentations of the disease. Several investigations and studies have provided valuable evidence on the etiopathogenesis of sarcoidosis, which may lead to the future development of targeted and innovative treatment strategies. Nevertheless, we are still a long way from unravelling the underlying cause of this mysterious disease.
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Affiliation(s)
- Georgi Tchernev
- Policlinic for Dermatology and Venereology, University Hospital Lozenetz, Academic Educational Hospital of The Saint Kliment Ohridski University, Koziak street 1, 1407, Sofia, Bulgaria.
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[Uncommon cutaneous ulcerative and systemic sarcoidosis. Successful treatment with hydroxychloroquine and compression therapy]. Hautarzt 2012; 62:691-5. [PMID: 21656110 DOI: 10.1007/s00105-010-2120-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sarcoidosis is a granulomatous multisystemic disease of unclear etiology, which can affect any organ. The cutaneous manifestations are variable, but ulcerative cutaneous sarcoidosis is very rare. One must rule out other granulomatous skin diseases, especially necrobiosis lipoidica. There is no standarized therapy; usually an interdisciplinary approach over years taking multiple side effects into consideration is needed. A 58-year-old woman with a long history of cutaneous, nodal and pulmonary sarcoidosis suddenly developed ulcerations within the disseminated skin lesions on her legs. The combination of systemic hydroxychloroquine and modern wound management lead to complete healing of the ulcers and a significant improvement in the remaining skin lesions.
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69
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Tanyildizi T, Kotan OS, Ozkaya S, Ersoz S, Gumus A. Skinsarcoidosis: A trick for primary case physicians. Respir Med Case Rep 2012; 5:49-50. [PMID: 26029589 PMCID: PMC3920437 DOI: 10.1016/j.rmedc.2011.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 09/13/2011] [Indexed: 11/18/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown etiology. Skin lesions occur in about a quarter of patients with sarcoidosis and specific manifestations include erythema nodosum, maculopapular eruption, plaques, lupus pernio and scar sarcoidosis. A 39-year old male presented with cutaneous involvement of sarcoidosis. The skin biopsy revealed non-caseating granuloma. Our patient had skin manifestation of makulopapular eruption form of skinsarcoidosis along with hilar and mediastinal lymphadenopathy. The 40 mg/day oral methylprednisolone was started and skin lesions were fully recovered. We report a case of skin involvement as a first sign of sarcoidosis.
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Affiliation(s)
- Taner Tanyildizi
- Rize Education and Research Hospital, Department of Dermatology, Rize, Turkey
| | - Ozgür Sadik Kotan
- Rize Education and Research Hospital, Department of Dermatology, Rize, Turkey
| | - Sevket Ozkaya
- Rize University, Faculty of Medicine, Department of Pulmonary Medicine, Rize, Turkey
- Corresponding author. Tel.: +90 532 4741309; fax: +90 464 2123015.
| | - Safak Ersoz
- Karadeniz Technical University, Faculty of Medicine, Department of Pathology, Trabzon, Turkey
| | - Aziz Gumus
- Rize University, Faculty of Medicine, Department of Pulmonary Medicine, Rize, Turkey
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70
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Heath CR, David J, Taylor SC. Sarcoidosis: Are there differences in your skin of color patients? J Am Acad Dermatol 2012; 66:121.e1-14. [DOI: 10.1016/j.jaad.2010.06.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 06/03/2010] [Accepted: 06/06/2010] [Indexed: 01/19/2023]
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Hameed OA, Skibinska M. Scar sarcoidosis with bone marrow involvement and associated musculoskeletal symptoms. BMJ Case Rep 2011; 2011:bcr.02.2011.3863. [PMID: 22669984 DOI: 10.1136/bcr.02.2011.3863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Sarcoidosis affects the lungs most commonly and can present with cutaneous lesions. It can also involve the bone marrow in rare instances, often presenting with non-specific symptoms such as fever and malaise, with occasional haematological abnormalities. The authors present the case of a 41-year-old caucasian female who was diagnosed with scar sarcoidosis, but who also reported fatigue, night sweats and polyarthralgia. No haematological abnormalities or lung involvement were detected. A magnetic resonance scan of the spine, performed due to disc prolapses, demonstrated areas of bone oedema and stress response that were reported as a possible sarcoid infiltration of the bone marrow. An improvement occurred after 8 weeks, despite conservative treatment. Bone marrow involvement in sarcoidosis is rarely reported, and was an accidental finding here. Due to the non-specific presentation, cases such as this are potentially underdiagnosed and should be considered in patients with systemic symptoms, regardless of their haematological status.
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Affiliation(s)
- Omair Akhtar Hameed
- General Medicine Department, Basildon University Hospital, London, Essex, UK.
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Abstract
Many cutaneous conditions can mimic infection. If these lesions are not accurately recognized, they may be treated with antimicrobial agents, which adds cost, potential risk, and inconvenience to the patient and the healthcare system. The presenting signs and symptoms of many ulcerating, pustular, morbilliform, bullous, neoplastic, granulomatous, autoimmune, and neutrophilic conditions, as well as clinical vasculitis, cellulitis, folliculitis, and panniculitis, have been mistaken for infection. This review emphasizes the clinical presentation, physical exam, and diagnostic workup of many of these conditions to assist the clinician in ascertaining the correct diagnosis. In addition, general treatment options are provided for each disease category.
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Affiliation(s)
- Janelle R Ricketts
- Dermatology Department, University of CT Health Center, Farmington, CT 06030, USA.
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73
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Ahmad Y, Shahril NS, Hussein H, Said MSM. Case Review of Sarcoidosis Resembling Sjogren's Syndrome. J Clin Med Res 2011; 2:284-8. [PMID: 22043264 PMCID: PMC3194035 DOI: 10.4021/jocmr482w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2010] [Indexed: 11/06/2022] Open
Abstract
We would like to report a case of a 29-year-old male patient who presented with multiple lymphadenopathy and vague symptoms of low grade fever, cough, weight loss, rashes, vomiting, dry eyes and dry mouth. Physical examination revealed submandibular lymphadenopathy, vasculitic rashes over both lower limbs, and parotid gland enlargement. Blood investigations showed mild anemia with leukocytosis, predominantly eosinophilia and high erythrocyte sedimentation rate and C-reactive protein. Computed tomography of the neck, thorax and abdomen showed bilateral submandibular, submental adenopathy, mediastinal and para-aortic lymphadenopathy with generalized reticulonodular densities in both lower lobes. There were hepatomegaly and bilateral enlarged kidneys with renal cyst. Histopathological examination from the cervical lymph node later revealed non-caseating granuloma, consistent of sarcoidosis. Patient responded well to prednisolone 50 mg daily with subsequent reduction in the size of cervical lymphadenopathy and parotid swelling.
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74
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Kim YJ, Shin JW, Lee JS, Park YL, Whang KU, Lee SY. Childhood granulomatous periorificial dermatitis. Ann Dermatol 2011; 23:386-8. [PMID: 21909215 PMCID: PMC3162274 DOI: 10.5021/ad.2011.23.3.386] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 07/26/2010] [Accepted: 07/26/2010] [Indexed: 11/08/2022] Open
Abstract
Childhood granulomatous periorificial dermatitis (CGPD), also known as facial Afro-Caribbean childhood eruption (FACE), is a distinctive granulomatous form of perioral dermatitis. It is a condition of unknown etiology, characterized by monomorphous, small, papular eruptions around the mouth, nose and eyes that histopathologically show a granulomatous pattern. It affects prepubescent children of both sexes and typically persists for several months but resolved without scarring. We report a 9 year-old girl with multiple, discrete, monomorphic, papular eruptions of 2-months duration on the perioral and periocular areas. Histopathological examination demonstrated upper dermal and perifollicular granulomatous infiltrate.
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Affiliation(s)
- Yoon Jee Kim
- Department of Dermatology, College of Medicine, Soonchunhyang University, Cheonan, Korea
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75
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Marcoval J, Mañá J, Rubio M. Specific cutaneous lesions in patients with systemic sarcoidosis: relationship to severity and chronicity of disease. Clin Exp Dermatol 2011; 36:739-44. [PMID: 21790725 DOI: 10.1111/j.1365-2230.2011.04128.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Specific (granulomatous) cutaneous lesions are seen in 9-37% of cases of systemic sarcoidosis, and are usually classified into maculopapules, plaques, lupus pernio (LP), scar sarcoidosis, and subcutaneous sarcoidosis. Their prognostic significance has not been fully established. AIM To analyse the relationship between the clinical type of granulomatous cutaneous lesions and the systemic features and prognosis of systemic sarcoidosis. METHODS The clinical charts of 86 patients (19 men, 67 women, mean age 46.82 years) with systemic sarcoidosis and granulomatous cutaneous involvement followed up for > 2 years at Bellvitge University Hospital were reviewed. RESULTS Cutaneous lesions developed before or at the time of diagnosis of systemic sarcoidosis in 80.23% of patients. The main cutaneous lesions were classified as maculopapules (28 patients), plaques (31), LP (6), scar sarcoidosis (7) and subcutaneous sarcoidosis (14). Erythema nodosum (EN) was seen in 30 patients. Radiological stage was 0 for 8 patients, I for 48, II for 24, III for 5 and IV for 1. Systemic sarcoidosis activity persisted for > 2 years in 47 patients, and 42 received systemic corticosteroid treatment for their disease. Maculopapular and subcutaneous sarcoidosis were mainly seen in patients with EN and radiological stage I. Plaques and LP were associated with chronic disease and requirement for systemic corticosteroids. CONCLUSIONS Cutaneous granulomatous lesions are usually present at the diagnosis of systemic sarcoidosis, and the type of cutaneous involvement may have prognostic significance.
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Affiliation(s)
- J Marcoval
- Department of Dermatology, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain.
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Adaptive immune responses in primary cutaneous sarcoidosis. Clin Dev Immunol 2011; 2011:235142. [PMID: 21603192 PMCID: PMC3095245 DOI: 10.1155/2011/235142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Accepted: 01/27/2011] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is a multisystemic inflammatory disorder with cutaneous lesions present in about one-quarter of the patients. Cutaneous lesions have been classified as specific and nonspecific, depending on the presence of nonnecrotizing epithelial cell granulomas on histologic studies. The development and progression of specific cutaneous sarcoidosis involves a complex interaction between cells of the adaptive immune systems, notably T-lymphocytes and dendritic cells. In this paper, we will discuss the role of T-cells and skin dendritic cells in the development of primary cutaneous sarcoidosis and comment on the potential antigenic stimuli that may account for the development of the immunological response. We will further explore the contributions of selected cytokines to the immunopathological process. The knowledge of the adaptive immunological mechanisms operative in cutaneous sarcoidosis may subsequently be useful for identifying prevention and treatment strategies of systemic sarcoidosis.
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77
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NAKAHIGASHI K, MIYACHI Y, UTANI A. Extensive lichenoid sarcoidosis intermingled with white papules. J Dermatol 2011; 38:829-32. [DOI: 10.1111/j.1346-8138.2010.01107.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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78
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Chen W, Mempel M, Traidl-Hofmann C, Al Khusaei S, Ring J. Gender aspects in skin diseases. J Eur Acad Dermatol Venereol 2011; 24:1378-85. [PMID: 20384686 DOI: 10.1111/j.1468-3083.2010.03668.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gender differences in medicine have been recognized in anatomy, physiology, as well as in epidemiology and manifestations of various diseases. With respect to skin disorders, males are generally more commonly afflicted with infectious diseases while women are more susceptible to psychosomatic problems, pigmentary disorders, certain hair diseases, and particularly autoimmune as well as allergic diseases. Significantly, more female sex-associated dermatoses can be identified than the male sex-associated dermatoses. Dermatoses in the genital area differ between men and women. Gender differences also exist in the occurrence and prognosis of certain skin malignancies. The mechanisms underlying gender differences in skin diseases remain largely unknown. Differences in the skin structure and physiology, effect of sex hormones, ethnic background, sociocultural behaviour and environmental factors may interact to exert the influences. A better understanding of gender differences in human health and diseases will allow the development of novel concepts for prevention, diagnosis and therapy of skin diseases.
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Affiliation(s)
- W Chen
- Department of Dermatology and Allergy, Helmholtz Zentrum Munchen/TUM, ZAUM-Center for Allergy and Environment, Technische Universität München, Germany.
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79
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Kluger N, Debu A, Guillot B, Girard C. Une infiltration violine de l’oreille externe. Rev Med Interne 2011; 32:114-5. [DOI: 10.1016/j.revmed.2010.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/30/2010] [Indexed: 11/25/2022]
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80
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Balma-Mena A, Cammisuli S. Icthyosiform eruption and swollen articulations in a girl. Clin Pediatr (Phila) 2011; 50:81-3. [PMID: 20118089 DOI: 10.1177/0009922809351572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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81
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Mehrotra R, Dhingra V. Cytological diagnosis of sarcoidosis revisited: A state of the art review. Diagn Cytopathol 2010; 39:541-8. [DOI: 10.1002/dc.21455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 05/01/2010] [Indexed: 12/16/2022]
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Abstract
Sarcoidosis is a systemic disease of unknown etiology that is characterized by noncaseating granulomatous inflammation of various organs. Isolated nasal cutaneous involvement is very uncommon (0.3%-4.0% of the patients reported) and rarely do sarcoid lesions present as severe nasal deformities and surgical treatment is rarely warranted. We present a 52-year-old black female patient who first was diagnosed with sarcoidosis in the early 1980s and had been treated traditionally for over 25 years and has developed a severe nasal deformity in which surgical treatment was warranted. Although severe nasal deformities caused by sarcoidosis are very uncommon, this case demonstrates a simple and straight forward surgical approach to obtain an excellent nasal reconstruction.
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83
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Nakahigashi K, Kabashima K, Akiyama H, Utani A, Miyachi Y. Refractory cutaneous lichenoid sarcoidosis treated with tranilast. J Am Acad Dermatol 2010; 63:171-2. [DOI: 10.1016/j.jaad.2009.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 03/03/2009] [Accepted: 04/20/2009] [Indexed: 11/29/2022]
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84
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Jung YJ, Roh MR. Clinical and histopathological analysis of specific lesions of cutaneous sarcoidosis in Korean patients. J DERMATOL TREAT 2010; 22:11-7. [PMID: 20524878 DOI: 10.3109/09546630903440098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sarcoidosis is a multi-systemic, non-caseating, granulomatous disorder of unknown origin. OBJECTIVE The purpose of our investigation was to describe the clinicopathological characteristics of specific lesions of cutaneous sarcoidosis and treatment outcomes in Korean patients. METHODS A retrospective review was made of 31 patients who were diagnosed with sarcoidosis at Severance Hospital, Yonsei University Health System in Korea between 2000 and 2008; these patients were enrolled in this study. The diagnosis of cutaneous sarcoidosis was made in 17 of the patients. They were confirmed by histopathologic examinations. The clinical features were analyzed through review of medical records, and histopathologic and radiologic examinations. RESULTS The patients' primary complaints were cutaneous symptoms (51.6%) and respiratory symptoms (32.3%). The most common presentation of cutaneous sarcoidal lesions was the nodule-plaque form (41.2%) and systemic organ involvement was observed in six cases (35.3%). Treatment modalities included steroid, hydroxychloroquine, cyclosporine, topical tacrolimus, and pulsed dye laser. In our series, five patients (30%) achieved complete resolution of the cutaneous lesions and 10 patients (60%) showed partial resolution after corticosteroid treatment. Also, patients without extracutaneous symptoms responded better to corticosteroid treatment compared to patients with systemic involvement. CONCLUSIONS These data reveal the diversity of clinical and histopathologic findings of cutaneous sarcoidosis in Korea.
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Affiliation(s)
- Ye-Jin Jung
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
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85
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Gangopadhyay A, Das JK, Sengupta S. Sarcoidosis with photosensitive lesions: a rare variant. Indian J Dermatol 2010; 54:90-2. [PMID: 20049285 PMCID: PMC2800887 DOI: 10.4103/0019-5154.49004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Ali MM, Atwan AA, Gonzalez ML. Cutaneous sarcoidosis: updates in the pathogenesis. J Eur Acad Dermatol Venereol 2009; 24:747-55. [PMID: 20015176 DOI: 10.1111/j.1468-3083.2009.03517.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sarcoidosis is a multiorgan granulomatous disease in which the skin is one of the frequently involved target organs. Cutaneous involvement occurs in a third of patients with sarcoidosis and has protean manifestations. More than a century has passed since the initial description of sarcoidosis, but its cause continues to be an enigma. Recent studies have introduced several new insights into the pathogenesis of this disease. The aim of this literature review was to provide a comprehensive overview on the current updates in the pathogenesis of sarcoidosis. This review has revealed that several genetic polymorphisms are associated with an increased risk of developing sarcoidosis, suggesting that genetic susceptibility to sarcoidosis is probably polygenic. Environmental factors may also modify the susceptibility to sarcoidosis. Evidence favouring an infectious aetiology has been accumulating, but the results of studies are conflicting. The current concept is that the pathogenesis of sarcoidosis involves a T-helper-1-mediated immune response to environmental antigens in a genetically susceptible host. The studies carried out on sarcoidosis have largely focused on the pulmonary aspects and have been mainly conducted by respiratory physicians. In contrast, research conducted on the cutaneous aspects of sarcoidosis is comparatively limited. Although tremendous advances have been made, there is a significant gap between the vast knowledge accumulated on sarcoidosis in recent years and the understanding of this disease.
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Affiliation(s)
- M M Ali
- Department of Dermatology, School of Medicine, Cardiff University, Cardiff, UK.
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87
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Quezada S, Turner PL, Alexiev B, Daly B, Cross R. Severe refractory orofacial Crohn's disease: report of a case. Dig Dis Sci 2009; 54:2290-5. [PMID: 19082722 DOI: 10.1007/s10620-008-0588-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/17/2008] [Indexed: 12/20/2022]
Abstract
Oral involvement is common in patients with Crohn's disease (CD) and can precede intestinal symptoms, making diagnosis difficult. We report a case of severe orofacial CD. A 41-year-old woman presented with palate and tongue ulcers. Biopsies showed acute inflammation with ulcer. Colonoscopy demonstrated ascending colon ulceration. Biopsies revealed acute colitis and mild architectural distortion. Prednisone was started but the symptoms recurred with taper; steroids were resumed and infliximab (IFX) 5 mg/kg was infused. After improvement, oral pain and weight loss returned. A G tube was placed. Mercaptopurine was started at 1.5 mg/kg per day. IFX was increased to 10 mg/kg. Debridement of the oral ulcers and a skin graft to the lips was performed. Pathology from oral and facial lesions was consistent with granulation tissue and fibrosis with chronic inflammation. She was readmitted several months later for weight loss and dehydration. Abdominal pain, distension, and feculent drainage developed around the G tube. Repeat computed tomography (CT) scan demonstrated pneumatosis. Laparotomy revealed purulent drainage from a perforated segment of sigmoid colon. Histology was consistent with perforated CD. Despite ventilatory and hemodynamic support and broad-spectrum antibiotics, the patient died 1 week later. Our case highlights the difficulty in diagnosing and managing orofacial CD. In this case, medical treatment was initiated based on a high index of suspicion. CD was only confirmed after intestinal resection very late in the disease course. Treatment of orofacial CD includes topical or systemic steroids, immunomodulators, and anti-tumor necrosis factor (TNF) therapies. As our case demonstrated, patients can be refractory to therapy.
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Affiliation(s)
- Sandra Quezada
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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88
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Pereira ESP, Vidigal MDR, Tebcherani AJ, Sanchez APG. Caso para diagnóstico. An Bras Dermatol 2009. [DOI: 10.1590/s0365-05962009000500018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A sarcoidose é uma doença sistêmica crônica idiopática caracterizada histologicamente por um acúmulo de fagócitos mononucleares e células gigantes, que levam à formação de granulomas não-caseosos em diversos órgãos. O envolvimento cutâneo ocorre, em aproximadamente, 25% dos casos, sendo representado por lesões específicas e não-específicas. Apresentamos caso raro de sarcoidose com lesões cutâneas papulosas e umbilicadas e envolvimento pulmonar.
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89
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White SD, Foley JE, Spiegel IB, Ihrke PJ. Lack of detectable equine herpesviruses 1 and 2 in paraffin-embedded specimens of equine sarcoidosis. J Vet Intern Med 2009; 23:623-5. [PMID: 19645844 DOI: 10.1111/j.1939-1676.2009.0291.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Equine sarcoidosis is a rare, multisystemic, noncaseating, granulomatous and lymphoplasmacytic disease of unknown etiology. A recent report described a horse with granulomatous skin disease displaying histologic, electron microscopic, and polymerase chain reaction (PCR) findings consistent with equine herpesvirus 2 (EHV-2). OBJECTIVE To investigate the presence of EHV-2 and equine herpesvirus 1 (EHV-1) in 8 horses with sarcoidosis. ANIMALS Eight horses with sarcoidosis, reported previously. METHODS Retrospective study. PCR assays of the tissues were performed to detect DNA associated with EHV-1 and EHV-2. For both herpesviruses the target was their respective glycoprotein B gene. Positive controls consisted of DNA from viral cultures of culturettes from naturally occurring respiratory infections of EHV-1 and EHV-2. RESULTS The PCR analyses for both equine herpesviruses' DNA were negative in all 8 horses. CONCLUSION The failure to detect DNA from EHV-1 and EHV-2 in paraffin-embedded skin of these 8 horses does not discount EHV-1 or EHV-2 as causing some cases of ES, but lends support to the presumably multifactorial etiologic nature of the disease.
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Affiliation(s)
- S D White
- Department of Medicine and Epidemiology, University of California, Davis, CA 95616, USA.
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90
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Drug-Induced Hypersensitivity Syndrome With Superficial Granulomatous Dermatitis-A Novel Finding. Am J Dermatopathol 2009; 31:611-3. [DOI: 10.1097/dad.0b013e3181a18d64] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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91
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92
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Zhang JX, Kerbleski JF, Gottlieb AB. Manifestations of cutaneous sarcoidosis: a case report of an African American woman. J Natl Med Assoc 2009; 101:614-7. [PMID: 19585935 DOI: 10.1016/s0027-9684(15)30955-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cutaneous sarcoidosis is challenging to diagnose due to its many nonspecific manifestations. In this report we describe a case of cutaneous sarcoidosis in a patient presenting with multiple lesions. Diagnosis of the disease involves not only clinical and pathologic findings but also multiple exclusions.
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Affiliation(s)
- Jing X Zhang
- Department of Dermatology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
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93
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Chen HH, Chen YM, Lan HHC, Lee CH, Chen DY. Sonographic appearance of subcutaneous sarcoidosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:813-816. [PMID: 19470823 DOI: 10.7863/jum.2009.28.6.813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Hsin-Hua Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Section 3, Taichung-Kang Rd, 40705 Taichung, Taiwan
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94
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Duparc A, Canonne-Courivaud D, Rose C, Creusy C, Modiano P. Sarcoïdose cutanée pseudotumorale associée à un lymphome malin non hodgkinien. Ann Dermatol Venereol 2009; 136:518-21. [DOI: 10.1016/j.annder.2009.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 01/09/2009] [Indexed: 10/20/2022]
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95
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Cardoso JC, Cravo M, Reis JP, Tellechea O. Cutaneous sarcoidosis: a histopathological study. J Eur Acad Dermatol Venereol 2009; 23:678-82. [DOI: 10.1111/j.1468-3083.2009.03153.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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96
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Mishriki YY. Puzzles in practice. Sarcoidosis. Postgrad Med 2009; 121:159-60. [PMID: 19179825 DOI: 10.3810/pgm.2009.01.1967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yehia Y Mishriki
- Penn State University College of Medicine, Allentown, PA 18103, USA.
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97
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Abstract
Infiltration of sarcoid granuloma in old cutaneous scars is one of the uncommon cutaneous manifestations of sarcoidosis. Here, we report the case of a 47-year-old female who presented with swelling and irritation in 5 old scars. She had acquired these scars 9 years ago in a traffic accident. An incisional scar biopsy revealed noncaseating granulomas consistent with sarcoidosis. High-resolution CT (HRCT) revealed right paratracheal, both hilar, paraaortic, and subcarinal lymphadenopathy without any nodular densities in both lung fields. Successful regression of cutaneous inflammation was achieved using a short course of oral steroids.
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Affiliation(s)
- Young Chul Hong
- Department of Internal Medicine, Sun General Hospital, Daejeon, Korea
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98
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Lichenoid Sarcoidosis: A Case With Clinical and Histopathological Lichenoid Features. Am J Dermatopathol 2008; 30:271-3. [DOI: 10.1097/dad.0b013e318166f43b] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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99
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100
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Affiliation(s)
- Christy B Doherty
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77005, USA
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