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Ahmed YA, Yusuf WH, Almubarak AJ, Ali MA, Tharwat S. Darier-Roussy Subcutaneous Sarcoidosis Masquerading as Multiple Abscesses: A Report of a Rare Case. Cureus 2024; 16:e61959. [PMID: 38978890 PMCID: PMC11229831 DOI: 10.7759/cureus.61959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/10/2024] Open
Abstract
Sarcoidosis is an idiopathic multisystemic granulomatous disease that mainly affects the lungs. Darier-Roussy subcutaneous sarcoidosis is among the specific and least encountered skin manifestations of sarcoidosis. In this case study, we report how subcutaneous sarcoidosis could mimic multiple abscesses presentation and hinder reaching a definitive diagnosis. A 65-year-old female presented with five, multiple, deep-seated skin lesions on the forearm, chest, and scalp. The lesions showed redness and tenderness. The patient also experienced arthralgia in the right ankle. Laboratory workup of the patient showed a high erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count. The patient was suspected to have multiple abscesses, which were managed with antibiotics with no response. Thus, a computed tomography (CT) scan of the chest was done and showed mediastinal lymphadenopathy. A biopsy was taken from one of the right forearm skin lesions, and it revealed characteristic features consistent with sarcoidosis. The patient was managed with hydroxychloroquine and a tapering dose of prednisone. Therefore, subcutaneous sarcoidosis should be included in the differential diagnosis of subcutaneous lumps.
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Affiliation(s)
- Yusuf A Ahmed
- Faculty of Medicine, Mansoura University, Mansoura, EGY
| | - Walaa H Yusuf
- Faculty of Medicine, Mansoura University, Mansoura, EGY
| | | | - Manar A Ali
- Faculty of Medicine, Mansoura University, Mansoura, EGY
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, EGY
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Koneti J, Cherukuri SP, Gadde S, Kalluru R, Chikatimalla R, Dasaradhan T. Sarcoidosis and Its Dermatological Manifestations: A Narrative Review. Cureus 2022; 14:e28053. [PMID: 36127956 PMCID: PMC9481194 DOI: 10.7759/cureus.28053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is an enigma diagnosed by ruling out other etiologies of granulomatous inflammation. The multisystem manifestations of sarcoidosis and the clinical polymorphism pose a diagnostic challenge to all physicians. The skin is the most commonly affected organ after the lungs in sarcoidosis. Dermatological manifestations can appear before, during, or after systemic involvement, and the type of skin lesion can have prognostic significance. Also, a biopsy of skin lesions is less invasive and more accessible to perform than a biopsy of visceral organs. Thus, in certain ways, cutaneous manifestations can aid in the diagnosis and prognosis of systemic disease. This article has focused on the frequently encountered skin lesions of sarcoidosis along with their prevalence, clinical features, and management.
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3
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Randhawa KS, Lee BW, Micali G, Benson BE, Schwartz RA. Cutaneous sarcoidosis: Lupus pernio and more. Ital J Dermatol Venerol 2022; 157:220-227. [PMID: 35274876 DOI: 10.23736/s2784-8671.21.07027-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sarcoidosis is a multi-organ disease commonly evident with skin involvement. Cutaneous manifestations occur in about 25% of sarcoid patients and are of two types: histologically specific sarcoidal infiltrations and a cutaneous reaction pattern not containing sarcoidal changes, usually erythema nodosum. Cutaneous plaques, nodules, and tumors, sometimes with disfiguring facial features associated with pain and paresthesia. The disease itself may produce substantial morbidity due to visceral involvement. Advances in therapeutic options include tocilizumab, an IL-6 inhibitor, and tofacitinib, a Janus kinase inhibitor. This review discusses sarcoidosis etiology and pathogenesis, its clinical features, differential diagnosis, and management.
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Affiliation(s)
| | - Brian W Lee
- Rutgers-New Jersey Medical School, Newark, NJ, USA
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4
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Gabaldon-Perez A, Garcia-Blas S, Forner MJ, López-Lereu MP, Bonanad C. Cardiac sarcoidosis as an incidental finding: A case report. Heart Lung 2020; 49:783-787. [PMID: 32980628 DOI: 10.1016/j.hrtlng.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This case illustrates the evaluation of a healthy young male with ECG anomalies in a perioperative electrocardiogram (ECG) that ended up with the diagnosis of a severe systemic disease. CASE A 28-year-old man was attended at the outpatient cardiology department to perform a preoperative ECG for lacrimal duct obstruction surgery, which showed Q and T negative waves in inferior leads. Echocardiogram and cardiac magnetic resonance (CMR) displayed left ventricular (LV) aneurysm at basal segments of the inferior, posterior, and lateral wall with myocardial thinning and dyskinesia. CMR and thoracic computed tomography (CT) showed bilateral nodular images in parotid glands, cervical, and thoracic lymphadenopathies. All those findings suggested the diagnosis of sarcoidosis, which was supported by Gallium-67 single-photon emission computed tomography (SPECT) results and finally confirmed by skin biopsy. CONCLUSIONS The present case highlights the complexity of sarcoidosis diagnosis. This young male was apparently asymptomatic; however, at presentation, he actually had three manifestations of active sarcoidosis: lacrimal duct obstruction, skin lesions, and cervical lymphadenopathies. It is essential to have a low threshold for sarcoidosis suspicion in the setting of unexplained systemic signs and symptoms.
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Affiliation(s)
| | - Sergio Garcia-Blas
- Department of Cardiology, University Clinical Hospital, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Maria J Forner
- Department of Internal Medicine, University Clinical Hospital, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - Clara Bonanad
- Department of Cardiology, University Clinical Hospital, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain.
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Nabli N, Gammoudi R, Aounallah A, Sriha B, Belajouza C, Denguezli M. Verrucous sarcoidosis: a diagnosis to keep in mind. Pan Afr Med J 2020; 36:228. [PMID: 33708319 PMCID: PMC7908315 DOI: 10.11604/pamj.2020.36.228.21487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022] Open
Abstract
Skin manifestations of sarcoidosis occur in up to 30% of cases, and may be the sentinel sign of the disease, with the skin being sometimes exclusively affected. While this may facilitate an early dermatologic diagnosis, heterogeneity in the cutaneous morphologies of sarcoidosis complicates recognition and affirms its reputation as a “great imitator”. Here, we present a case of a verrucous version of sarcoidosis that may be misdiagnosed because it can mimic other inflammatory and neoplastic skin disorders. Although it is a rare variant, its presence should alert clinicians to the likelihood of systemic involvement of cutaneous sarcoidosis.
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Affiliation(s)
- Nadia Nabli
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Rima Gammoudi
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Amina Aounallah
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Badreddine Sriha
- Department of Anatomopathology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Colandane Belajouza
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Denguezli
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
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6
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Tchernev G, Patterson JW, Wollina U, Lotti T, Temelkova I. Granulomatous slack skin mycosis fungoides developing simultaneously with sarcoid-like lesions in a patient with repeated anabolic injections in the past? Dermatol Ther 2020; 33:e13200. [PMID: 31854482 DOI: 10.1111/dth.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/16/2019] [Indexed: 12/01/2022]
Abstract
We present a 32-year-old man with successful treatment and remission of mycosis fungoides of both axillae in 2016 after PUVA therapy and systemic and local administration of corticosteroids. Subsequently, in 2017, the patient also achieved remission of a T-cell CD 30 positive, ALK-1 negative large-cell lymphoma of a retroperitoneal and inguinal lymph node after chemotherapy and radiotherapy. One year later, in 2018, the patient presented to our clinic with progression of skin lesions in both axillary areas and the appearance of а tumor in the right gluteal region.Dermatological examination showed livid-to-erythematous, partly sclerotic plaques in the right inguinal area, cutis laxa-like plaque formations in the right axillary region with similar but less-developed changes in the left axillary fold, a solitary subcutaneous tumor formation affecting the entire right gluteal region, and enlarged, palpable lymph nodes in the right para-axillary area. Biopsies were obtained from an axillary lesion and the surgically removed axillary lymph nodes, and histological examination revealed changes of granulomatous slack skin in the axilla and reactive inflammatory changes in the lymph nodes. Histology of gluteal tissue showed a "foreign body" type of reaction with sarcoid-like features, where the patient in the past have been injected with anabolic and steroidal drugs. Herein we describe a patient with simultaneous occurrence of granulomatous slack skin type mycosis fungoides and a sarcoid-like reaction. The question remains open whether this represents the so-called sarcoidosis-lymphoma syndrome or, more likely, granulomatous slack skin MF associated with a sarcoid-like reaction of "foreign body" type. The possibility that disturbance of tissue homeostasis by incorporation of certain adjuvants within injections (for example) in the past might have been an inducer of cutaneous T cell lymphoma and sarcoidosis/sarcoid like lesions seems reasonable but also speculative.
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Affiliation(s)
- Georgi Tchernev
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - James W Patterson
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Torello Lotti
- Department of Dermatology and Venereology, University of Rome "G. Marconi", Rome, Italy
| | - Ivanka Temelkova
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a rare, multisystem granulomatous disease of incompletely understood pathogenesis. Clinically, it shares common features with several systemic and organ-specific autoimmune diseases, although known autoantibodies or useful serologic markers for diagnosis and monitoring of disease activity are lacking. Sarcoidosis can both coexist with or mimic connective tissue diseases or vasculitis. Here, we review possible common etiologic factors between sarcoidosis and autoimmune disease, comparing clinical, laboratory and imaging features. RECENT FINDINGS Autoimmune diseases may precede or follow the diagnosis of sarcoidosis. Overall, the prevalence of both co-existing is unknown because of limited evidence. The presence of autoantibodies in sarcoidosis should raise suspicion of an underlying autoimmune disease that mimics or co-occurs with sarcoidosis. Silica dust exposure has been associated with an increased prevalence of both sarcoidosis and rheumatoid arthritis. In another study, autoimmune thyroid disease, Sjogren's syndrome and ankylosing spondylitis have been reported to be more frequent in sarcoidosis compared with healthy controls. SUMMARY A systematic diagnostic work-up is necessary to detect overlapping disease features in patients with sarcoidosis. Immune-modulating therapies need to be taken into account as these can induce paradoxical reactions.
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Arora P, Sardana K, Gautam RK, Batrani M. Relevant diagnostic implications of the therapeutic challenge with antitubercular therapy in an unusual case of sarcoidosis mimicking lupus vulgaris. Dermatol Ther 2019; 32:e12968. [PMID: 31099451 DOI: 10.1111/dth.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/27/2022]
Abstract
Cutaneous manifestations in sarcoidosis are seen in 25-35% of patients with systemic disease and may be the sole manifestation in few patients. It is known that isolated cutaneous sarcoidosis is a great mimicker and can be easily misdiagnosed as other granulomatous conditions especially lupus vulgaris in regions with high burden of tuberculosis (TB). Here we present a case with cutaneous sarcoidosis who was initially misdiagnosed and treated as bifocal lupus vulgaris with antitubercular therapy (ATT) for 6 months. This nonresponsiveness to therapy prompted us to investigate the patient further for other differentials, failing which a diagnosis of cutaneous sarcoidosis was made and the patient was treated with oral steroids and methotrexate with complete clearance of lesions after 14 weeks of therapy. Our case reemphasizes the value of therapeutic trial of ATT in diagnosis of cutaneous TB and highlights the remarkable clinical mimic of sarcoidosis with lupus vulgaris.
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Affiliation(s)
- Pooja Arora
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Ram Krishan Gautam
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Meenakshi Batrani
- Department of Pathology, Delhi Dermpath Laboratory, Delhi Dermatology Group, New Delhi, India
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9
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García-Colmenero L, Sánchez-Schmidt JM, Barranco C, Pujol RM. The natural history of cutaneous sarcoidosis. Clinical spectrum and histological analysis of 40 cases. Int J Dermatol 2018; 58:178-184. [PMID: 30306543 DOI: 10.1111/ijd.14218] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/27/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous lesions of sarcoidosis can allow physicians to establish the diagnosis of a systemic disease, but the need of monitoring patients presenting skin limited sarcoidosis in order to detect further extracutaneous involvement has rarely been evaluated. OBJECTIVES To review clinical and histological features of patients with cutaneous sarcoidosis and the risk of progression to systemic disease. To characterize the phenotype of patients with isolated cutaneous sarcoidosis and to assess the temporal relationship between cutaneous and systemic disease. METHODS Retrospective review of a series of patients with cutaneous sarcoidosis. Clinical, histopathological, and evolutive features were reviewed. RESULTS Forty patients were included in the study. Systemic disease was present in 82.5% of patients. Previous or concurrent cutaneous involvement occurred in 81.8% of them. Seven out of 14 patients with cutaneous lesions evolved to a systemic sarcoidosis in a mean time of 6 years, with a range between 4 and 9 years. No clinical or histological differences were found between patients with systemic sarcoidosis and those who showed persistent isolated cutaneous lesions. CONCLUSIONS Sarcoidosis may be manifested as an isolated cutaneous disorder. No clinical or histopathological features seem to be helpful to discriminate cases of a persistent isolated cutaneous disease from those that will develop systemic involvement. Since the development of systemic involvement in cases of isolated cutaneous sarcoidosis can occur many years afterward, careful monitoring seems advisable, and a long follow-up is recommended.
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10
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Terziroli Beretta-Piccoli B, Mainetti C, Peeters MA, Laffitte E. Cutaneous Granulomatosis: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 54:131-146. [PMID: 29352388 DOI: 10.1007/s12016-017-8666-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cutaneous granulomatosis is a heterogeneous group of diseases, characterized by a skin inflammatory reaction triggered by a wide variety of stimuli, including infections, foreign bodies, malignancy, metabolites, and chemicals. From a pathogenic point of view, they are divided into non-infectious and infectious granulomas. Pathophysiological mechanisms are still poorly understood. Non-infectious granulomatous skin diseases include granuloma annulare, necrobiosis lipoidica, rheumatic nodules, foreign body granulomas, cutaneous sarcoidosis, and interstitial granulomatous dermatitis. Necrobiosis lipoidica is more frequent in diabetic patients. Infectious granulomas of the skin are caused by mycobacteria, in particular Mycobacterium tuberculosis or atypical mycobacteria; parasites, such as Leishmania; or fungi. Pathogenic mechanisms of M. tuberculosis-related granuloma are discussed. From a clinical point of view, it is useful to divide cutaneous granulomatosis into localized and more disseminated forms, although this distinction can be sometimes artificial. Three types of localized granulomatous lesions can be distinguished: palisaded granulomas (granuloma annulare, necrobiosis lipoidica, and rheumatoid nodules), foreign body granulomas, and infectious granulomas, which are generally associated with localized infections. Disseminated cutaneous granulomas can be divided into infectious, in particular tuberculosis, and non-infectious forms, among which sarcoidosis and interstitial granulomatous dermatitis. From a histological point of view, the common denominator is the presence of a granulomatous inflammatory infiltrate in the dermis and/or hypodermis; this infiltrate is mainly composed of macrophages grouped into nodules having a nodular, palisaded or interstitial architecture. Finally, we propose which diagnostic procedure should be performed when facing a patient with a suspected cutaneous granulomatosis.
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Affiliation(s)
| | - Carlo Mainetti
- Department of Dermatology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | | | - Emmanuel Laffitte
- Clinique de Dermatologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland.
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11
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Hinojosa T, Lewis DJ, Sharghi KG, Ramos E, Peranteau J, Vangipuram R, Rapini RP, Tyring SK. Verrucous eyebrows: a cutaneous manifestation of a systemic disease. J Eur Acad Dermatol Venereol 2017; 31:e430-e432. [PMID: 28370475 DOI: 10.1111/jdv.14246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Hinojosa
- Faculty of Medicine, University of Monterrey, San Pedro Garza Garcia, NL, Mexico
| | - D J Lewis
- School of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K G Sharghi
- Center for Clinical Studies, Houston, TX, USA
| | - E Ramos
- Center for Clinical Studies, Houston, TX, USA
| | - J Peranteau
- Center for Clinical Studies, Houston, TX, USA
| | | | - R P Rapini
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S K Tyring
- Center for Clinical Studies, Houston, TX, USA.,Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
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12
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Holl-Ulrich K, Rose C. [Non-infectious granulomatous inflammation: Focus on the lungs and skin]. DER PATHOLOGE 2017; 37:172-82. [PMID: 26670175 DOI: 10.1007/s00292-015-0119-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whereas a granulomatous reaction represents a physiologically useful immune defense mechanism against many infections, in autoimmune diseases granuloma formation and the concomitant inflammatory mechanisms may provoke a potentially organ-threatening reaction. Morphologically, several defined sub-types of granuloma have long been known, e.g. foreign body granuloma, tuberculous granuloma,sarcoid, pseudosarcoid, rheumatoid and rheumatic fever granulomas. However, in practice, assigning granulomas to a certain etiology from a biopsy or resection specimen can be a challenging diagnostic process. This article gives a practically oriented overview of the clinically most relevant non-infectious granulomatous diseases. The etiology, epidemiology, clinical correlation and morphology of granulomatous diseases are discussed, focussing on the lungs and skin.
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Affiliation(s)
- K Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. .,Gemeinschaftspraxis für Pathologie am Lademannbogen, Hamburg, Deutschland.
| | - C Rose
- Dermatopathologie Lübeck, Lübeck, Deutschland
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13
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Mohammadpour I, Motazedian MH, Handjani F, Hatam GR. Lip leishmaniasis: a case series with molecular identification and literature review. BMC Infect Dis 2017; 17:96. [PMID: 28122496 PMCID: PMC5264488 DOI: 10.1186/s12879-016-2178-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucocutaneous leishmaniasis (MCL), a protozoan infectious disease, is very rare in Iran despite the endemicity of both cutaneous and visceral forms. It is transmitted by the Phlebotomus sand fly. The lip is considered one of the extraordinary sites. Lesions usually initiate with erythematous papules, slowly enlarges and then it ulcerates. The diagnosis of MCL encompasses epidemiological, clinical and laboratory aspects. Usually, the combination of some of these elements is necessary for the final diagnosis. So, lip leishmaniasis lesions can be challenging to diagnose. CASE PRESENTATION We presented seven rare cases of lip leishmaniasis. Tissue impression smear, culture, PCR and phylogenetic analysis were carried out for explicit diagnosis. Skin scraping investigation showed several Leishmania spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for Leishmania spp. PCR was positive for L. major, L. tropica, and L. infantum. Differential diagnosis includes orofacial granulomatosis, basal cell carcinoma, squamous cell carcinoma, and mesenchymal tumors. The cases were treated with systemic meglumine antimoniate (Glucantime®). No relapses were observed during 1 year of follow-up. Early detection of the infection are necessary in order to start effective treatment and prevent more serious complications. CONCLUSIONS In this paper, we reported seven rare cases of lip leishmaniasis in Iran, emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic kinship of isolated parasites, and reviewed the literature on lip leishmaniasis.
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Affiliation(s)
- Iraj Mohammadpour
- Department of Medical Parasitology & Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Motazedian
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Handjani
- Department of Dermatology, Molecular Dermatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Hatam
- Department of Medical Parasitology & Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Paravina M, Ljubenović M, Stanojević M, Stepanović M, Marković D. Cutaneous Sarcoidosis in a patient with left Hilar calcification of the lungs - A Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2016. [DOI: 10.1515/sjdv-2016-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractSarcoidosis is an acquired idiopathic granulomatous disease, which is characterized by noncaseating epithelioid granulomas in organs and tissues. Most frequently it affects the lungs, liver, lymph nodes, skin, eyes and other organs. The cutaneous lesions appear in 20 - 30% of patients with systemic manifestations, and in 25% of them they appear without systemic manifestations. Based on the histopathological characteristics, cutaneous lesions are divided into specific, characterized by cutaneous granuloma, and non-specific, which are not granulomatous. Moreover, they can be classified as typical and atypical. We are presenting a female patient with unilateral hilar calcification of the lungs, who exhibited plaque skin lesions typical for sarcoidosis, with a specific granulomatous histology and a favorable response to corticosteroid and antimalarial therapy.
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15
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Clinical and radiological features of extra-pulmonary sarcoidosis: a pictorial essay. Insights Imaging 2016; 7:571-87. [PMID: 27222055 PMCID: PMC4956623 DOI: 10.1007/s13244-016-0495-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/07/2016] [Accepted: 04/22/2016] [Indexed: 12/19/2022] Open
Abstract
Abstract The aim of this manuscript is to describe radiological findings of extra-pulmonary sarcoidosis. Sarcoidosis is an immune-mediated systemic disease of unknown origin, characterized by non-caseating epitheliod granulomas. Ninety percent of patients show granulomas located in the lungs or in the related lymph nodes. However, lesions can affect any organ. Typical imaging features of liver and spleen sarcoidosis include visceromegaly, with multiple nodules hypodense on CT images and hypointense on T2-weighted MRI acquisitions. Main clinical and radiological manifestations of renal sarcoidosis are nephrolithiasis, nephrocalcinosis, and acute interstitial nephritis. Brain sarcoidosis shows multiple or solitary parenchymal nodules on MRI that enhance with a ring-like appearance after gadolinium. In spinal cord localization, MRI demonstrates enlargement and hyperintensity of spinal cord, with hypointense lesions on T2-weighted images. Skeletal involvement is mostly located in small bone, showing many lytic lesions; less frequently, bone lesions have a sclerotic appearance. Ocular involvement includes uveitis, conjunctivitis, optical nerve disease, chorioretinis. Erythema nodosum and lupus pernio represent the most common cutaneous manifestations encountered. Sarcoidosis in various organs can be very insidious for radiologists, showing different imaging features, often non-specific. Awareness of these imaging features helps radiologists to obtain the correct diagnosis. Teaching Points • Systemic sarcoidosis can exhibit abdominal, neural, skeletal, ocular, and cutaneous manifestations. • T2 signal intensity of hepatosplenic nodules may reflect the disease activity. • Heerfordt’s syndrome includes facial nerve palsy, fever, parotid swelling, and uveitis. • In the vertebrae, osteolytic and/or diffuse sclerotic lesions can be found. • Erythema nodosum and lupus pernio represent the most common cutaneous manifestations.
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17
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Elfatoiki FZ, Soussi W, Chiheb S, Jabri L, Benchikhi H. Cutaneous sarcoidosis simulating porokeratosis of Mibelli. Pan Afr Med J 2015; 20:195. [PMID: 26113926 PMCID: PMC4469506 DOI: 10.11604/pamj.2015.20.195.5003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 03/02/2015] [Indexed: 11/28/2022] Open
Abstract
We report a skin localization of systemic sarcoidosis, which presented with lesions that resemble porokeratosis of Mibelli. Skin biopsy showed non-caseating sarcoidal granuloma. Whereas cutaneous sarcoidosis is present in up to one-third of cases and may present with a wide variety of lesions, our presentation is uncommon. Partial remission was obtained with hydroxychloroquine and prednisone
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Affiliation(s)
| | - Wessal Soussi
- CHU Ibn Rochd, Service de Dermatologie, Casablanca, Maroc
| | - Soumia Chiheb
- CHU Ibn Rochd, Service de Dermatologie, Casablanca, Maroc
| | - Lamia Jabri
- Centre de Pathologie Casapath, Casablanca, Maroc
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18
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Expression of Notch signaling components in cutaneous foreign body and sarcoidal granulomas and fusing macrophages. Am J Dermatopathol 2014; 36:409-13. [PMID: 24394305 DOI: 10.1097/dad.0b013e3182a730cb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The evolutionarily conserved Notch signaling pathway affects tissue-specific cell differentiation, proliferation, and apoptosis. In the immune system, Notch has been implicated in the development and function of both adoptive and innate immune cells. Notch signaling is initiated by Notch receptor binding to cognate ligands, which results in the enzymatic cleavage and intranuclear translocation of the intracellular domain of Notch receptor (ICN). Recent murine models of chronic inflammation highlighted a critical role for a Notch ligand, Delta-like ligand (Dll)-4, in granuloma formation. In this study, we aimed to assess Notch-1 receptor activation and Dll4 expression in human cutaneous granulomas and in cultured human macrophages and multinucleated giant cells. ICN1 and Dll4 expression was evaluated by immunohistochemistry of cutaneous foreign body (n = 15) and sarcoidal (n = 19) granulomas. The results showed consistent intranuclear staining for ICN1 in foreign body but not in sarcoidal granulomas and strong cytoplasmic staining for Dll4 in mononuclear histiocytes and multinucleate giant cells in both types of granulomas. Additionally, immunofluorescence confocal microscopy showed ICN1 and Dll4 expression by cultured human macrophages undergoing fusion in the presence of granulocyte-macrophage colony-stimulating factor and interleukin-4. These findings indicate a potential role for the Notch-1-Dll4 signaling pathway in foreign body-induced granulomatous reactions and possibly distinct Notch pathway utilization in sarcoidal granulomas.
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Annular sarcoidosis mimicking granuloma annulare: a case report. North Clin Istanb 2014; 1:114-116. [PMID: 28058314 PMCID: PMC5175062 DOI: 10.14744/nci.2014.32042] [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: 05/01/2014] [Accepted: 06/09/2014] [Indexed: 11/20/2022] Open
Abstract
Cutaneous sarcoidosis is a great imitator and we have to remember this mimicker also in the differential diagnosis of erythematous annular lesions. We report the case of a 50-year- old man with a 7-year history of erythematous, annular or serpiginous, scaly plaques on his scalp, forehead, preauricular region and around his mouth who was misdiagnosed as granuloma annulare.
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Chokoeva AA, Tchernev G, Tana M, Tana C. Exclusion criteria for sarcoidosis: A novel approach for an ancient disease? Eur J Intern Med 2014; 25:e120. [PMID: 25457837 DOI: 10.1016/j.ejim.2014.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/08/2014] [Indexed: 12/17/2022]
Affiliation(s)
| | - Georgi Tchernev
- Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, Sofia, Bulgaria
| | - Marco Tana
- Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Claudio Tana
- Internal Medicine Unit, Guastalla Hospital, Reggio Emilia, Italy
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Tchernev G, Cardoso JC, Chokoeva AA, Verma SB, Tana C, Ananiev J, Gulubova M, Philipov S, Kanazawa N, Nenoff P, Lotti T, Wollina U. The "mystery" of cutaneous sarcoidosis: facts and controversies. Int J Immunopathol Pharmacol 2014; 27:321-30. [PMID: 25280023 DOI: 10.1177/039463201402700302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The reason why the cutaneous form of sarcoidosis is well known in the literature is because of its spectrum of manifestations granting it the fame of a Great Imitator. The mystery shrouding the pathogenesis of this rare cutaneous disease is still there (in spite of the fundamental progress of the various diagnostic methods in current day medicine). The production of the morphological substrate - the epithelioid cell granuloma - which is considered to be characteristic of skin sarcoidosis, could, however, also be the end result of a reaction to i) various specific infectious agents such as Leishmaniasis cutis, coccidioidomycosis, etc., ii) certain residual bacterial or other mycobacterial antigens which, at the moment of setting the diagnosis are - by definition - non-infectious but still immunogenic, as well as iii) different tumor antigens in lesional tissue or other location. Often, differentiating between sarcodiosis and a sarcoid-like reaction, based on the updated criteria for cutaneous sarcoidosis, is problematic to downright impossible. A future characterization of the genetic signature of the two conditions, as well as the implementation of additional mandatory panels for i) the identification of certain infectious or ii) non-infectious but immunogenic and iii) tumor antigens in the epithelioid cell granuloma (or in another location in the organism), could be a considerable contribution to the process of differentiating between the two above-mentioned conditions. This will create conditions for greater accuracy when setting the subsequent therapeutic approaches.
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Affiliation(s)
- G Tchernev
- Policlinic for Dermatology and Venerology, Saint Kliment Ohridski University, Medical Faculty, University Hospital Lozenetz, Sofia, Bulgaria
| | - J C Cardoso
- Dermatology Department University Hospital of Coimbra, Pinto, Coimbra, Portugal
| | - A A Chokoeva
- Department of Dermatology and Venereology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - C Tana
- Department of Medicine and Science of Aging "G. d'Annunzio" University, Chieti, Italy
| | - J Ananiev
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - M Gulubova
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - S Philipov
- Department of General and Clinical Pathology, Medical Faculty, "Saint Kliment Ohridski University", Sofia, Bulgaria
| | - N Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - P Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
| | - T Lotti
- Dermatology Department, University of Rome "G. Marconi" Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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22
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Sehgal VN, Riyaz N, Chatterjee K, Venkatash P, Sharma S. Sarcoidosis as a systemic disease. Clin Dermatol 2014; 32:351-63. [DOI: 10.1016/j.clindermatol.2013.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Sarcoidosis vs. Sarcoid-like reactions: The Two Sides of the same Coin? Wien Med Wochenschr 2014; 164:247-59. [DOI: 10.1007/s10354-014-0269-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/17/2014] [Indexed: 12/18/2022]
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24
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Moraitis AG, Hewison M, Collins M, Anaya C, Holick MF. Hypercalcemia associated with mineral oil-induced sclerosing paraffinomas. Endocr Pract 2013; 19:e50-6. [PMID: 23337133 DOI: 10.4158/ep12092.cr] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Granuloma-forming diseases such as sarcoidosis are associated with extrarenal synthesis of 1,25-dihydroxyvitamin D [1,25(OH)₂D]. We describe a case of extensive skin lesions associated with mineral oil injections in which we provide evidence for cutaneous granuloma synthesis of 1,25(OH)₂D in the pathogenesis of the patient's hypercalcemia. METHODS Analysis of expression of the 25(OH)D-1a-hydroxylase (1-a OHase [CYP27b1]) was carried out by immunohistochemical analysis of involved skin. RESULTS In involved skin, expression of CYP27b1 was found in the dermis, where it is not normally expressed. Successful management of hypercalcemia was achieved with glucocorticoids. CONCLUSIONS Hypercalcemia associated with mineral oil induced skin lesions is likely driven by unregulated expression of CYP27b1 by inflammatory monocytes and macrophages infiltrating the dermis.
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Affiliation(s)
- Andreas G Moraitis
- Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, Maryland, USA.
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[Skin and soft tissue infections due to non-tuberculous mycobacteria: etiology, epidemiology, pathogenesis, differential diagnostic aspects and therapeutic recommendations]. Wien Med Wochenschr 2012; 161:426-32. [PMID: 22016064 DOI: 10.1007/s10354-011-0027-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/09/2011] [Indexed: 10/16/2022]
Abstract
Non-tuberculous mycobacteria are rarely responsible for skin and soft tissue infections. These infections are caused by different mycobacterial species originating from the environment (water, soil, plants, and animals). Various factors influence the clinical manifestation of the cutaneous infection: the immunological situation of the patient, the degree of cutaneous impairment, and the extent of the contact with the contaminated environment. The clinical manifestation is non-specific and often the cause of extensive diagnostic activities. The diagnosis is based on the cultural detection of the causative pathogen. The management of these skin and subcutaneous infections is a challenge for each physician. The treatment comprises administration of several antibiotics and antituberculosis drugs for many months. Surgical procedures are necessary in some patients.
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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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Kaplan J, Burgin S, Sepehr A. Granulomatous pigmented purpura: report of a case and review of the literature. J Cutan Pathol 2011; 38:984-9. [DOI: 10.1111/j.1600-0560.2011.01744.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ríos-Martín J, Ferrándiz-Pulido L, Moreno-Ramírez D. Aproximación al diagnóstico dermatopatológico de las lesiones figuradas. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:316-24. [DOI: 10.1016/j.ad.2010.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/23/2010] [Accepted: 12/26/2010] [Indexed: 11/26/2022] Open
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30
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Ríos-Martín J, Ferrándiz-Pulido L, Moreno-Ramírez D. Approaches to the Dermatopathologic Diagnosis of Figurate Lesions. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/s1578-2190(11)70814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Extensive lichenoid type of Cutaneous sarcoidosis - A case report / Ekstenzivna lihenoidna saroidoza kože. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2011. [DOI: 10.2478/v10249-011-0034-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Cutaneous manifestations of sarcoidosis are present in up to 25% of patients. The manifestatons can be very variable, making this disease one of the „great imitators“ in dermatology. One of its clinical variants is lichenoid sarcoidosis, which is more commonly described in children. We report an adult patient with extensive lichenoid sarcoidosis with a personal history of treated pulmonary tuberculosis, without any evidence of actual pulmonary involvement with sarcoidosis. The main differential diagnosis of lichenoid sarcoidosis of lichen scrofulosorum, so thorough examinations, to exclude active tuberculosis, are essential in theses cases. The patient was succesfully treated with antimalarial drugs, and lowdose systemic corticosteroids.
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