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Cedirian S, Comellini V, Chessa MA, Ravaioli GM, Misciali C, Nava S, LA Placa M. Subcutaneous sarcoidosis: a case series from a single center. Ital J Dermatol Venerol 2024; 159:344-348. [PMID: 38808460 DOI: 10.23736/s2784-8671.24.07711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Sarcoidosis is a multisystemic granulomatous disease which not only affect the skin but can also involve the lymph nodes, eyes, and lungs. Subcutaneous sarcoidosis (SCS), is a rare form of sarcoidosis which is generally more prevalent in women in their 40s and 50s, characterized by subcutaneous, flesh-colored nodules, mostly localized on the limbs. A retrospective study to investigate clinical features and response to treatment in patients affected by SCS. METHODS All patients with systemic and/or cutaneous sarcoidosis visited in our clinic hospital between 2012 and 2022. Out of this group, clinical features, and management of SCS patients were analyzed. RESULTS Out of 102 patients with specific lesions of cutaneous sarcoidosis, with or without systemic involvement, 13 (13%) were diagnosed with SCS. CONCLUSIONS Our study confirms that systemic involvement in SCS is the prevalent finding as expected. Moreover, SCS patients have a relatively good prognosis, and systemic treatment does not differ from first-line therapies for cutaneous sarcoidosis.
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Affiliation(s)
- Stephano Cedirian
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Vittoria Comellini
- Unit of Respiratory and Critical Care Unit, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Marco A Chessa
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giulia M Ravaioli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Stefano Nava
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Respiratory and Critical Care Unit, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Michelangelo LA Placa
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy -
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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2
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Dev A, Malhi K, Chatterjee D, De D. Unmasking the Great Imitator: A Clinicopathological Challenge. Indian Dermatol Online J 2024; 15:564-565. [PMID: 38845664 PMCID: PMC11152481 DOI: 10.4103/idoj.idoj_516_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/06/2023] [Accepted: 12/24/2023] [Indexed: 06/09/2024] Open
Affiliation(s)
- Anubha Dev
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kittu Malhi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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3
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Miyaue K, Hoshi T, Isono H. Ulcerative sarcoidosis: An atypical cause of leg ulcers. Clin Case Rep 2024; 12:e8592. [PMID: 38444914 PMCID: PMC10912090 DOI: 10.1002/ccr3.8592] [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: 06/16/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
We present the case of an 83-year-old woman with leg ulcers who was diagnosed with sarcoidosis. This case highlights the importance for clinicians to consider ulcerative sarcoidosis when encountering patients with leg ulcers along with hilar adenopathy, uveitis, elevated serum angiotensin-converting enzyme, and histopathological findings of epithelioid cell granulomas.
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Affiliation(s)
- Kazuki Miyaue
- Department of General MedicineHITO Medical CenterEhimeJapan
| | - Tetsuya Hoshi
- Department of General Internal MedicineTeine Keijinkai HospitalSapporoJapan
| | - Hiroki Isono
- Department of General MedicineHITO Medical CenterEhimeJapan
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4
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Woo YR, Kim HS. Deciphering Childhood Rosacea: A Comprehensive Review. J Clin Med 2024; 13:1126. [PMID: 38398439 PMCID: PMC10889684 DOI: 10.3390/jcm13041126] [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: 12/25/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Childhood rosacea is a lesser known, yet significant, skin condition presenting diagnostic and treatment challenges. Although often underdiagnosed due to unclear diagnostic criteria, it manifests similarly to adult rosacea, with features such as papulopustular, telangiectasia, granulomatous, idiopathic facial aseptic granuloma, and ocular rosacea. The complex pathophysiology involves genetic, immunological, and environmental factors. Distinguishing childhood rosacea from conditions like acne, steroid rosacea, sarcoidosis, and lupus vulgaris is crucial but complicated by the lack of established criteria. Treatment strategies, mainly extrapolated from adult management protocols, include topical therapies, systemic medications, and laser treatments, adapted for pediatric patients. Special attention is given to ocular rosacea, often preceding skin manifestations, necessitating multidisciplinary care. The review underscores the urgent need for clear diagnostic guidelines, increased awareness, and tailored pediatric treatment protocols to improve patient outcomes and mitigate the condition's evolution into adulthood.
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Affiliation(s)
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Republic of Korea;
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5
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Kanakamedala AD, Maamari RN, Couch SM. Tattoo-associated lacrimal gland enlargement and sarcoidosis. Am J Ophthalmol Case Rep 2023; 32:101889. [PMID: 37521806 PMCID: PMC10371775 DOI: 10.1016/j.ajoc.2023.101889] [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: 12/14/2022] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To describe a case of tattoo-associated sarcoidosis presenting with cutaneous findings of tattoo granulomas and ophthalmic manifestation of isolated bilateral lacrimal gland enlargement. Observations A 35-year-old female presented with bilateral upper eyelid swelling for over a year. She reported no associated episodes of ocular pain or visual decline since onset of eyelid edema. On examination, the lacrimal glands were firm and enlarged bilaterally. Slit-lamp examination demonstrated no evidence of active or prior ocular inflammation. Further systemic examination revealed multiple raised papules within a 4-year-old chest/shoulder tattoo. Histopathology from a lacrimal gland biopsy showed non-caseating granulomas consistent with sarcoidosis. Conclusions and importance The authors report a rare case of a 35-year-old presenting with isolated dacryoadenitis and tattoo granulomas found to be a tattoo-associated sarcoidosis. Although uveitis is a commonly described ocular manifestation in tattoo-associated sarcoidosis, few reports have described lacrimal gland enlargement as a presenting ophthalmic feature in tattoo-associated sarcoidosis.
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6
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Liu M, Chen H, Xu F. Dermoscopy of cutaneous sarcoidosis: a cross-sectional study. An Bras Dermatol 2023; 98:750-754. [PMID: 37487766 PMCID: PMC10589496 DOI: 10.1016/j.abd.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Although traditionally used for the diagnosis of skin tumors, in the past few years dermoscopy as a clinical diagnostic aid for inflammatory and infectious skin manifestations has also received more and more attention. The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Dermoscopy can be used as an auxiliary examination method. OBJECTIVE Our aim was to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of CS. METHODS This was a retrospective analysis of 39 CS clinical and dermoscopic images collected in the Department of Dermatology, Huashan Hospital Affiliated with Fudan University from August 2013 to February 2021. RESULTS Retrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures in all 39 cases. Variable diameter linear vessels were found in 38 cases. A central scar-like area was seen in 26 cases. Bright white streaks were seen in 30 cases. The follicular plugs were seen in 15 cases. STUDY LIMITATIONS First, the number of cutaneous sarcoidosis cases the authors collected is small. Second, due to the lack of a control group, the sensitivity and specificity of the proposed criteria were not calculated. Finally, since our study mainly includes suspicious lesions that were biopsied for diagnostic purposes, there may be a selection bias. CONCLUSION Lesions showing on dermoscopy grouped translucent orange ovoid structures associated with linear vessels should raise the suspicion of CS. Central scar-like areas and bright white streaks are also helpful in the diagnosis of CS.
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Affiliation(s)
- Mengguo Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huyan Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
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Al Yacoub R, Brown K, Ladna M. Successful multidisciplinary treatment of the rare pathology of vulvar Crohn's disease. BMJ Case Rep 2023; 16:e256343. [PMID: 37844980 PMCID: PMC10583072 DOI: 10.1136/bcr-2023-256343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
A woman in her 50s with a medical history of rheumatoid arthritis (RA) and hypothyroidism presented with 3 months of vaginal pain and swelling. Physical examination showed vulvar oedema and erythema, ulcerations of the inferior vulva that extended to the buttocks and introitus with erythema and superficial erosions. MR pelvis showed a fibroid in the uterus but otherwise was unremarkable. Biopsies of the vagina showed extensive acute and chronic inflammation, necrosis and granulomas without concern for malignancy, which was consistent with a diagnosis of cutaneous Crohn's disease. MR enterography, upper endoscopy and colonoscopy revealed no gastrointestinal manifestations of Crohn's. She was treated initially with corticosteroids and metronidazole as well as vulvectomy and graft placement. Azathioprine was added to her regimen due to lack of response; however, despite 6 weeks of this therapy, the ulcerations did not heal thus infliximab was initiated. After 8 weeks the lesions had completely resolved.
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Affiliation(s)
- Raed Al Yacoub
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kelcie Brown
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael Ladna
- Department of Medicine, University of Florida, Gainesville, Florida, USA
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8
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Lai J, Almazan E, Le T, Taylor MT, Alhariri J, Kwatra SG. Demographics, Cutaneous Manifestations, and Comorbidities Associated with Progressive Cutaneous Sarcoidosis: A Retrospective Cohort Study. MEDICINES (BASEL, SWITZERLAND) 2023; 10:57. [PMID: 37887264 PMCID: PMC10608652 DOI: 10.3390/medicines10100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Background: Sarcoidosis is a multisystem granulomatous disease with a wide variety of presentations and clinical courses. Cutaneous manifestations and comorbidities associated with sarcoid prognosis remain understudied. Methods: An EPIC query was run for patients age 18+ at the Johns Hopkins Hospital with a diagnosis of sarcoidosis of the skin according to the ICD-10-CM code D86.3. Data were obtained from a population-based sample of 240 patients from 2015 to 2020. Results: A total of 240 patients were included in the cohort study. The mean (SD) age was 43.76 (11.72) years, and 30% of participants were male; 76.25% of patients identified as black, 19.58% as white, and 4.17% as other. The average age of onset in remissive patients was significantly higher than progressive (47 ± 12 vs. 40 ± 10, p = 0.0005); 49% of black patients experienced progressive sarcoid compared to 32.6% of white patients (p = 0.028). Progressive disease was associated with the presence of lupus pernio (aOR = 3.29, 95% CI, 1.60-6.77) and at least one autoimmune comorbidity (aOR 6.831, 95% CI 1.819-11.843). Conclusions: When controlling for patient demographics, lupus pernio and the presence of at least one autoimmune condition were associated with progressive cutaneous sarcoidosis.
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Affiliation(s)
| | | | | | | | | | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.L.); (T.L.); (M.T.T.); (J.A.)
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9
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Aktas M, Tunc H, Zaben B, Arı N, Midi I, Cinel L, Ergun T. An unusual diagnosis for sporotrichoid nodular lesions: Subcutaneous sarcoidosis. Indian J Dermatol Venereol Leprol 2023; 0:1-2. [PMID: 37609755 DOI: 10.25259/ijdvl_582_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/21/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Meryem Aktas
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Handenur Tunc
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Baha Zaben
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nursah Arı
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ipek Midi
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Leyla Cinel
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
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10
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DAS P, Gupta A, Barui S, Singh GK, Bahuguna A, Sapra D, Gupta A, Bellad P. Puzzling papular eruptions on an old scar. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:275-276. [PMID: 38692631 DOI: 10.25259/nmji_652_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Pankaj DAS
- Department of Radiodiagnosis and Imaging, Base Hospital Delhi Cantt, Delhi 110010, India
| | - Amul Gupta
- Department of Radiodiagnosis and Imaging, Base Hospital Delhi Cantt, Delhi 110010, India
| | - Sanghita Barui
- Department of Pathology, Base Hospital Delhi Cantt, Delhi 110010, India
| | - Gautam Kumar Singh
- Department of Dermatology, Base Hospital Delhi Cantt, Delhi 110010, India
| | - Amit Bahuguna
- Department of Dermatology, Base Hospital Delhi Cantt, Delhi 110010, India
| | - Devyani Sapra
- Department of Dermatology, Base Hospital Delhi Cantt, Delhi 110010, India
| | - Akanksha Gupta
- Department of Dermatology, Base Hospital Delhi Cantt, Delhi 110010, India
| | - Prashant Bellad
- Department of Dermatology, Base Hospital Delhi Cantt, Delhi 110010, India
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11
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Zaouak A, Chamli A, Ben Samir A, Hlel I, Ben Brahim E, Fenniche S, Hammami H. A case of ulcerative cutaneous sarcoidosis. Indian J Dermatol Venereol Leprol 2023; 89:582-584. [PMID: 37067119 DOI: 10.25259/ijdvl_851_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/12/2022] [Indexed: 03/31/2023]
Affiliation(s)
- Anissa Zaouak
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia Research Unit "Genodermatoses and cancers LR12SP03,", Tunis, Tunisia
| | - Amal Chamli
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia Research Unit "Genodermatoses and cancers LR12SP03,", Tunis, Tunisia
| | - Asma Ben Samir
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia Research Unit "Genodermatoses and cancers LR12SP03,", Tunis, Tunisia
| | - Imen Hlel
- Department of Dermatology and Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia Research Unit "Genodermatoses and cancers LR12SP03,", Tunis, Tunisia
| | - Ehsen Ben Brahim
- Department of Dermatology and Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia Research Unit "Genodermatoses and cancers LR12SP03,", Tunis, Tunisia
| | - Samy Fenniche
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia Research Unit "Genodermatoses and cancers LR12SP03,", Tunis, Tunisia
| | - Houda Hammami
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia Research Unit "Genodermatoses and cancers LR12SP03,", Tunis, Tunisia
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12
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Haller CN, Schnebelen A, Cadmus SD. Sarcoidal Tattoo Granuloma After COVID-19 Vaccine. JAAD Case Rep 2023; 48:S2352-5126(23)00217-5. [PMID: 38620113 PMCID: PMC10300053 DOI: 10.1016/j.jdcr.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 04/17/2024] Open
Affiliation(s)
- Courtney N. Haller
- Division of Dermatology, Department of Internal Medicine, Dell Medical School, the University of Texas at Austin, Austin, Texas
| | | | - Simi D. Cadmus
- Division of Dermatology, Department of Internal Medicine, Dell Medical School, the University of Texas at Austin, Austin, Texas
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13
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Pons S, Dalac S, Aubriot-Lorton MH, Vervandier A, Landais C, Collet E. A case of ichtyosiform and morpheaform sarcoidosis. Ann Dermatol Venereol 2023; 150:52-55. [PMID: 36428122 DOI: 10.1016/j.annder.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/22/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Affiliation(s)
- S Pons
- Department of Dermatology, Dijon Bourgogne University Hospital Center, 14 rue Paul Gaffarel, 21000 Dijon, France.
| | - S Dalac
- Department of Dermatology, Dijon Bourgogne University Hospital Center, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - M H Aubriot-Lorton
- Department of Pathology, Dijon Bourgogne University Hospital Center, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - A Vervandier
- Department of Pathology, Dijon Bourgogne University Hospital Center, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - C Landais
- Department of Dermatology, Dijon Bourgogne University Hospital Center, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - E Collet
- Department of Dermatology, Dijon Bourgogne University Hospital Center, 14 rue Paul Gaffarel, 21000 Dijon, France
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14
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Systemic Sarcoidosis Presenting in a Scar. Case Rep Dermatol Med 2023; 2023:7751754. [PMID: 36733915 PMCID: PMC9889162 DOI: 10.1155/2023/7751754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023] Open
Abstract
While most forms of sarcoidosis of the skin do not require treatment, 40% of patients initially diagnosed with cutaneous sarcoidosis are found to have an asymptomatic disease involving other organ systems. It is the involvement of the lungs, heart, eyes, and nervous system which most often contributes to morbidity/mortality. An early and accurate diagnosis of sarcoidosis is difficult because patients may be asymptomatic, initial presentations may vary, and there is no single reliable diagnostic test except biopsy. We present a case of scar sarcoidosis which led to the diagnosis of stage II pulmonary sarcoidosis in a woman in her 50s. Her scar sarcoidosis presented as well-circumscribed, reddish-brown macules surrounding an atrophic scar from a prior skin graft on the right leg. Biopsy revealed scattered, well-formed, non-necrotizing granulomas of the dermis composed of epithelioid histiocytes and multinucleated giant cells, surrounded by a sparse infiltrate of lymphocytes and histiocytes. A CT chest demonstrated extensive hilar lymphadenopathy, leading to a diagnosis of stage II pulmonary sarcoidosis with cutaneous involvement. This case illustrates the interesting presentation of scar sarcoidosis and underscores the importance of a broad differential including sarcoidosis for skin changes around scars and underscores the need for early biopsy. Prompt cutaneous diagnosis leads to earlier systemic evaluation, therapeutics, and better outcomes.
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15
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Mesnyankina OA, Ryabov SK. Beck’s smallnodular sarcoid in dermatologist practice. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-2-188-193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The low incidence of skin sarcoidosis in the practice of a dermatologist, numerous clinical manifestations, similarities with other dermatoses cause difficulties in timely diagnosis, lead to diagnostic errors, and, as a consequence, untimely therapy. The presented clinical observation demonstrates the important role of conducting a detailed differential diagnostic search in patients with suspected skin sarcoidosis. Cutaneous manifestations of the pathological process can be combined with lesions of the lymph nodes, respiratory system and other organs, precede them or be isolated, in this regard, each patient with a verified diagnosis of skin sarcoidosis should be examined to exclude systemic signs of the disease. It should be emphasized that sarcoidosis of the skin can have a paraneoplastic character, being a marker of lymphoproliferative processes, myelodysplastic syndrome, therefore, correct and timely verification of the skin process may be a prerequisite for early diagnosis of other, possibly subclinically occurring pathological processes in the patient.
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16
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Brazile TL, Saul M, Nouraie SM, Gibson K. Characteristics and survival of patients diagnosed with cardiac sarcoidosis: A case series. Front Med (Lausanne) 2022; 9:1051412. [PMID: 36582282 PMCID: PMC9792839 DOI: 10.3389/fmed.2022.1051412] [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] [Received: 09/22/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Sarcoidosis is a multiorgan system granulomatous disease of unknown etiology. It is hypothesized that a combination of environmental, occupational, and/or infectious factors provoke an immunological response in genetically susceptible individuals, resulting in a diversity of manifestations throughout the body. In the United States, cardiac sarcoidosis (CS) is diagnosed in 5% of patients with systemic sarcoidosis, however, autopsy results suggest that cardiac involvement may be present in > 50% of patients. CS is debilitating and significantly decreases quality of life and survival. Currently, there are no gold-standard clinical diagnostic or monitoring criteria for CS. Methods We identified patients with a diagnosis of sarcoidosis who were seen at the Simmons Center from 2007 to 2020 who had a positive finding of CS documented with cardiovascular magnetic resonance (CMR) and/or endomyocardial biopsy as found in the electronic health record. Medical records were independently reviewed for interpretation and diagnostic features of CS including late gadolinium enhancement (LGE) patterns, increased signal on T2-weighted imaging, and non-caseating granulomas, respectively. Extracardiac organ involvement, cardiac manifestations, comorbid conditions, treatment history, and vital status were also abstracted. Results We identified 44 unique patients with evidence of CS out of 246 CMR reports and 9 endomyocardial biopsy pathology reports. The first eligible case was diagnosed in 2007. The majority of patients (73%) had pulmonary manifestations, followed by hepatic manifestations (23%), cutaneous involvement (23%), and urolithiasis (20%). Heart failure was the most common cardiac manifestation affecting 59% of patients. Of these, 39% had a documented left ventricular ejection fraction of < 50% on CMR. Fifty eight percent of patients had a conduction disease and 44% of patients had documented ventricular arrhythmias. Pharmacotherapy was usually initiated for extracardiac manifestations and 93% of patients had been prescribed prednisone. ICD implantation occurred in 43% of patients. Patients were followed up for a median of 5.4 (IQR: 2.4-8.5) years. The 10-year survival was 70%. In addition to age, cutaneous involvement was associated with an increased risk of death (age-adjusted OR 8.47, 95% CI = 1.11-64.73). Conclusion CMR is an important tool in the non-invasive diagnosis of CS. The presence of LGE on CMR in a pattern consistent with CS has been shown to be a predictor of mortality and likely contributed to a high proportion of patients undergoing ICD implantation to decrease risk of sudden cardiac death. Clinical implications Additional studies are necessary to develop robust criteria for the diagnosis of CS with CMR, assess the benefit of serial imaging for disease monitoring, and evaluate the effect of immunosuppression on disease progression.
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Affiliation(s)
- Tiffany L. Brazile
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Melissa Saul
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Seyed Mehdi Nouraie
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States
| | - Kevin Gibson
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States,*Correspondence: Kevin Gibson,
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17
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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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18
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Sui YA, Lai WLR, Liang WM, Lim ZV. Lower limb nodules. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:874-876. [PMID: 34877596 DOI: 10.47102/annals-acadmedsg.2021204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Yihao Abraham Sui
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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19
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Svigos K, Yin L, Fried L, Lo Sicco K, Shapiro J. A Practical Approach to the Diagnosis and Management of Classic Lichen Planopilaris. Am J Clin Dermatol 2021; 22:681-692. [PMID: 34347282 DOI: 10.1007/s40257-021-00630-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/01/2022]
Abstract
Lichen planopilaris is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp. Patients may also have associated scalp itching, burning or tenderness. Due to scarring, hair loss is typically permanent. The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss. Currently, the literature has limited evidence on treatments for this difficult condition, and most available evidence is from case reports and case series. Furthermore, the evidence shows a varied response to therapy, with frequent reports of poor response. This article reviews the diagnosis of this rare disease, summarize the currently available treatments, and provide insights and practices from alopecia experts.
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Affiliation(s)
- Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lu Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren Fried
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.
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20
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Suh SY, Ahn JH. Scar sarcoidosis with systemic involvement after blepharoplasty. Int J Ophthalmol 2021; 14:1288-1290. [PMID: 34414097 DOI: 10.18240/ijo.2021.08.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Su Youn Suh
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Jung Hyo Ahn
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Gyeongnam 50612, Republic of Korea
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21
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Modi T, Maniam G, Quirch M, Warraich I, Rehman S. Extrapulmonary sarcoidosis in an atypical patient demographic. Proc (Bayl Univ Med Cent) 2020; 34:151-152. [PMID: 33456182 DOI: 10.1080/08998280.2020.1824963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Although it typically presents with cough and dyspnea due to pulmonary involvement, sarcoidosis is a multisystem granulomatous disease and therefore may present with extrapulmonary manifestations. Cutaneous manifestations are common, while hepatic sarcoidosis is uncommon and osseous manifestations are exceedingly rare. This article describes osseous, hepatic, and cutaneous manifestations due to sarcoidosis. The patient was diagnosed with sarcoidosis, treated with a dynamic hip screw implant with a derotational screw, and discharged on a new medication regimen: vitamin D, calcium supplements, alendronate, methotrexate, and hydroxychloroquine.
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Affiliation(s)
- Trisha Modi
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ganesh Maniam
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Miguel Quirch
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Irfan Warraich
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Shabnam Rehman
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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22
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[Periorbital erythematous plaques and papules in an HIV-positive patient : A case report]. Hautarzt 2020; 71:711-714. [PMID: 32356073 DOI: 10.1007/s00105-020-04600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prior to the introduction of antiretroviral therapy, the concomitant occurrence of sarcoidosis and human immunodeficiency virus (HIV) was extremely rare. Today, an increased prevalence of sarcoidosis as a result of immune reconstitution syndrome (IRIS) is observed in HIV patients. A 37-year-old male patient that was co-infected with HIV and hepatitis C had a 6‑month history of gradually progressive asymptomatic periorbital erythematous plaques and papules. Routine clinical examinations were normal. Skin punch biopsy taken from the upper portion of the right cheek showed several non-caseating dermal granulomas with multinucleated giant cells, enabling unequivocal histological diagnosis. Based on the clinical picture and histological findings, the patient was diagnosed with cutaneous sarcoidosis. This case study underlines the change in possible rheumatological and dermatological comorbities in HIV-positive patients treated with highly active antiretroviral therapy. Therefore, physicians treating HIV infections should be familiar with the definition of IRIS.
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Clifford G, Silfvast‐Kaiser A, Paek SY. An unusual presentation of cutaneous sarcoidosis. Dermatol Ther 2020; 33:e13546. [DOI: 10.1111/dth.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - So Yeon Paek
- Division of Dermatology Baylor Scott & White Dallas Texas USA
- Texas A&M College of Medicine Dallas Texas USA
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24
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Diep D, Calame A, Cohen PR. Tinea Corporis Masquerading as a Diffuse Gyrate Erythema: Case Report and a Review of Annular Lesions Mimicking a Dermatophyte Skin Infection. Cureus 2020; 12:e8935. [PMID: 32760635 PMCID: PMC7392473 DOI: 10.7759/cureus.8935] [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] [Indexed: 11/05/2022] Open
Abstract
Tinea is a superficial fungal infection of the skin. Gyrate erythemas are reactive conditions that present as annular red lesions. A 61-year-old woman was diagnosed with tinea corporis whose skin lesions morphologically mimicked a gyrate erythema. She presented with diffuse annular plaques affecting the left side of her chest and abdomen that did not respond to a combination antifungal-corticosteroid cream for six-month duration. The appearance and clinical differential diagnosis included a gyrate erythema. Initial evaluation of the skin biopsy from the lesion's edge demonstrated a spongiotic dermatitis, and staining for fungal organisms was negative. However, deeper sections and a different fungal stain revealed hyphae in the stratum corneum and established a diagnosis of tinea corporis. The PubMed database was used to review the following terms: tinea corporis, gyrate erythema, and tinea incognito. Relevant papers and references cited in those papers that were generated by the search were used. Tinea corporis, especially if previously treated with topical corticosteroids, can masquerade as other dermatoses including a gyrate erythema. Correlation of clinical presentation and pathology findings is essential, especially if the biopsy results do not confirm the suspected clinical diagnosis. Consideration to perform deeper sections or additional special stains or both should also be entertained when the initial pathology observations do not support the presumptive diagnosis based on clinical morphology and history.
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Affiliation(s)
- Darlene Diep
- Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Antoanella Calame
- Dermatology/Dermatopathology, Compass Dermatopathology, San Diego, USA.,Dermatology, Scripps Memorial Hospital, La Jolla, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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Costin A, Cunha H. Visual Dermatology: Peculiar Form of Cutaneous Sarcoidosis. J Cutan Med Surg 2019; 23:643. [PMID: 31729911 DOI: 10.1177/1203475419858934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Maouni S, Sqalli A, El Anzi O, El Hadadi F, Mezni L, Elmeknassi I, Znati K, Meziane M, Benzekri L, Ismaili N, Senouci K, Hassam B. [Multiple crusty ulcerative lesions revealing systemic sarcoidosis]. Ann Dermatol Venereol 2019; 147:54-56. [PMID: 31676045 DOI: 10.1016/j.annder.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/20/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S Maouni
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc.
| | - A Sqalli
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - O El Anzi
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - F El Hadadi
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - L Mezni
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - I Elmeknassi
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - K Znati
- Service d'anatomo-pathologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - M Meziane
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - L Benzekri
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - N Ismaili
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - K Senouci
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
| | - B Hassam
- Service de dermatologie et de vénérologie, université Mohammed V., centre hospitalier universitaire Ibn Sina, Rabat, Maroc
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Abstract
The correct interpretation of skin manifestations can facilitate the diagnosis of many rare systemic diseases. Such manifestations can be due to autoimmune diseases (e.g. dermatomyositis, systemic lupus erythematosus, systemic sclerosis and sarcoidosis) and metabolic diseases (e.g. Anderson-Fabry disease and porphyria cutanea tarda). Other cutaneous symptoms are of great importance because they are possible warning signs of occult diseases of internal organs. This is true for example for some diseases from the group of neutrophilic dermatoses, such as Sweet's syndrome and pyoderma gangraenosum.
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Affiliation(s)
- Bruno Gualtieri
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland.
| | - Michael Hertl
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland
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28
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Arora S, Avinash Damle N, Passah A, Ray A, Soneja M, Banerjee S, Kaushal S, Jana M, Tripathi M, Bal C. Scar arcoidosis on 18F-FDG PET/CT. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2019; 7:185-187. [PMID: 31380459 PMCID: PMC6661307 DOI: 10.22038/aojnmb.2019.37888.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
18F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is an important imaging modality in the clinical workup of patients with chronic inflammatory disorders which present quite often with a fever of unknown origin. Sarcoidosis is a multisystem chronic inflammatory disorder with a wide clinical spectrum that can involve different organs. The diagnosis of sarcoidosis is usually based on the observation of noncaseating granulomas in biopsy specimens and exclusion of other granulomatous diseases. Skin involvement can occur in 20-25% of sarcoidosis cases. However, scar involvement in sarcoidosis is a rare condition. Herein, we present a case of multisystem sarcoidosis in a 45-year-old woman, who was previously treated with steroids and was in remission for 8 months. The patient presented with multiple skin nodules on the chest and back, a history of intermittent fever, headache, and mild itching at the abdominal scar site for 3 months. Blood investigations revealed elevated serum angiotensin-converting enzyme levels. The 18F-FDG PET/CT revealed a metabolically active involvement of the cutaneous tissue (posthysterectomy scar), apart from other sites of involvement. Biopsy of the scar site revealed multiple epithelioid cell granulomas with giant cells surrounding the collagenous fibers of the scar tissue.
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Affiliation(s)
- Saurabh Arora
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Averilicia Passah
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sayantan Banerjee
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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29
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Ho B, Choi KS, Ochoa W, Torralba KD, Sandhu VK, Pakbaz Z. Atypical manifestations of sarcoidosis in a Hispanic male. J Community Hosp Intern Med Perspect 2019; 9:271-274. [PMID: 31258873 PMCID: PMC6586134 DOI: 10.1080/20009666.2019.1607503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/09/2019] [Indexed: 10/26/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology that can present with nonspecific features, often resulting in delayed diagnosis. The diagnosis requires the demonstration of non-caseating granulomas on biopsy. While the prevalence of sarcoidosis in the USA is rare, the disease is rarer yet in Hispanics. It is for this reason that we report herein the case of a Hispanic gentleman with a unique clinical manifestations of sarcoidosis. With what began as a two-month history of joint pain and skin rash, this 55-year-old man was hospitalized with multiple joint pain, weight loss, fatigue and a pruritic rash with leonine facies in the setting of anemia, leukopenia, hypercalcemia, elevated serum creatinine, and urine Bence-Jones proteinuria. CT imaging of the chest was nonspecific, but skin biopsy revealed non-caseating granulomatous disease. After completing an infectious and malignancy evaluation, the patient was diagnosed with sarcoidosis, which was treated successfully with low-dose steroid therapy.
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Affiliation(s)
- Bao Ho
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA,Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Kristal S. Choi
- Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA,Division of Rheumatology, Loma Linda University, School of Medicine, Loma Linda, CA, USA,Department of Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - William Ochoa
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA,Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Karina D. Torralba
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA,Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA,Division of Rheumatology, Loma Linda University, School of Medicine, Loma Linda, CA, USA,Department of Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - Vaneet K. Sandhu
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA,Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA,Division of Rheumatology, Loma Linda University, School of Medicine, Loma Linda, CA, USA,Department of Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - Zahra Pakbaz
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA,Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA,Department of Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, USA,Hematology, Riverside University Health System Medical Center, Moreno Valley, CA, USA,CONTACT Zahra Pakbaz Department of Internal Medicine, University of California, Riverside, School of Medicine, 26520 Cactus Avenue, Moreno Valley, CA92555, USA
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31
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Blettery M, Brunier L, Banydeen R, Derancourt C, de Bandt M. Management of acute-stage chikungunya disease: Contribution of ultrasonographic joint examination. Int J Infect Dis 2019; 84:1-4. [PMID: 30930186 DOI: 10.1016/j.ijid.2019.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Chikungunya (CHIKV) is an arbovirus that causes acute, debilitating polyarthritis. Its diagnosis can be difficult for clinicians not used to managing joint diseases or detecting synovitis. Joint Doppler ultrasonography (DUS) is a simple, non-invasive examination, able to visualize synovitis. Its diagnostic and prognostic value in rheumatoid arthritis is well-established. METHODS Patients with serologically proven acute arbovirosis where included. Clinical examination and joint count were performed (DAS score). Ultrasound examination was performed by another clinician - experienced in joint DUS - who also performed ultrasound joint score. Joints were examined by DUS in B-mode looking for: subcutaneous infiltration, effusion, tenosynovitis, erosion and Doppler signal. RESULTS In our experience, joint DUS is able to detect effusions in 92.8% of painful joints, with 28.3% of the effusions emitting a high-power Doppler signal. No erosion was observed. Subcutaneous inflammatory infiltration of the ankles (aseptic cellulitis) was found in 28.6% of patients. CONCLUSION Joint DUS is able to detect objective signs responsible for joint pain, which can be useful for practitioners not accustomed to this type of pathology. It also makes possible distinction between articular and periarticular manifestations.
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Affiliation(s)
- Marie Blettery
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Lauren Brunier
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Rishika Banydeen
- Unit of Epidemiology and Biostatistics (USMR), Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Christian Derancourt
- Unit of Epidemiology and Biostatistics (USMR), Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Michel de Bandt
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France.
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32
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Hochman E, Ferenczi K, Payette MJ. A peculiar dermatomal plaque. Int J Dermatol 2019; 58:1132-1134. [PMID: 30888044 DOI: 10.1111/ijd.14430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Edward Hochman
- Department of Dermatology, UConn Health, Farmington, CT, USA
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33
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Atci T, Baykal C, Kaya Bingöl Z, Polat Ekinci A, Kiliçaslan Z. Scar sarcoidosis: 11 patients with variable clinical features and invariable pulmonary involvement. Clin Exp Dermatol 2019; 44:826-828. [DOI: 10.1111/ced.13917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- T. Atci
- Department of Dermatology and Venereology Istanbul Medical Faculty Istanbul University Istanbul Turkey
| | - C. Baykal
- Department of Dermatology and Venereology Istanbul Medical Faculty Istanbul University Istanbul Turkey
| | - Z. Kaya Bingöl
- Department of Pulmonary Medicine Istanbul Medical Faculty Istanbul University Istanbul Turkey
| | - A. Polat Ekinci
- Department of Dermatology and Venereology Istanbul Medical Faculty Istanbul University Istanbul Turkey
| | - Z. Kiliçaslan
- Department of Pulmonary Medicine Istanbul Medical Faculty Istanbul University Istanbul Turkey
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34
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Hubail A, Belkharoeva R, Tepluk N, Belerosova T. Lupus pernio (Besnier-Tenneson syndrome): A rare form of sarcoidosis. Dermatol Reports 2018; 10:7696. [PMID: 30555667 PMCID: PMC6250080 DOI: 10.4081/dr.2018.7696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/02/2018] [Indexed: 12/05/2022] Open
Abstract
Lupus pernio (LP) is a chronic non-life threatining type of cutaneous sarcoidosis that can be related to chronic fibrotic sarcoidosis, hyperglobulinemia and hypercalcemia. The aim of this case report is to evaluate the clinical and demographic features of cutaneous sarcoidosis mainly presenting with a rare manifestation of LP. In this paper we report a case of systemic sarcoidosis presenting with LP and a review of the available literature. LP is a rare presentation with infiltrated erythematoviolaceous plaques affecting the nose. We address the main management approach, and possible association with an underlying systemic sarcoidosis. LP is a rare but chronic manifestation of systemic sarcoidosis that needs to be treated in order to prevent cosmetic defects and psychological effects. It is important to recognize such a condition early in order to avoid a delay in treatment and worsening of the condition, both physically and psychologically. Further research regarding the diagnostic approach and management is required to understand this condition thoroughly.
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Affiliation(s)
- Amal Hubail
- Hospital of Skin and Venereal Disease Hospital named after VA Rakhmanov. I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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35
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Saleem MD, Oussedik E, Picardo M, Schoch JJ. Acquired disorders with hypopigmentation: A clinical approach to diagnosis and treatment. J Am Acad Dermatol 2018; 80:1233-1250.e10. [PMID: 30236514 DOI: 10.1016/j.jaad.2018.07.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
Acquired hypopigmented skin changes are commonly encountered by dermatologists. Although hypopigmentation is often asymptomatic and benign, occasional serious and disabling conditions present with cutaneous hypopigmentation. A thorough history and physical examination, centered on disease distribution and morphologic findings, can aid in delineating the causes of acquired hypopigmented disorders. The second article in this 2-part continuing medical education series focuses on conditions with a hypopigmented phenotype. Early diagnosis and appropriate management of these disorders can improve a patient's quality of life, halt disease progression, and prevent irreversible disability.
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Affiliation(s)
- Mohammed D Saleem
- Department of Internal Medicine, University of Florida College of Medicine and University of Florida Health, Gainesville, Florida.
| | | | - Mauro Picardo
- Department of Dermatology and Pediatric Dermatology, Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida, Gainesville, Florida; Department of Pediatrics, University of Florida, Gainesville, Florida
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36
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Abstract
Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.
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Conforti C, Giuffrida R, de Barros MH, Resende FSS, Cerroni L, Zalaudek I. Dermoscopy of a single plaque on the face: an uncommon presentation of cutaneous sarcoidosis. Dermatol Pract Concept 2018; 8:174-176. [PMID: 30116658 PMCID: PMC6092068 DOI: 10.5826/dpc.0803a04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022] Open
Abstract
Sarcoidosis is a multisystemic granulomatous disease of unknown causes, and cutaneous sarcoidosis (CS) is an early manifestation of the disease. Dermoscopy has gained increasing interest in the past few years as an aid in the clinical diagnosis of inflammatory and infectious skin manifestations. We present a case report about a single, erythematous, and asymptomatic plaque on the face with unexpected dermoscopy characteristics of CS. Learning points:
CS on the face of a therapy-resistant actinic keratosis should be considered a differential diagnosis. Dermoscopy can change the diagnosis and lead to the correct management.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- University of Messina, Department of Clinical and Experimental Medicine, Section of Dermatology, Messina, Italy
| | | | | | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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38
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Sarcoidosis Discovered During Mohs Surgery for Basal Cell Carcinoma. Dermatol Surg 2018; 44:125-126. [PMID: 28498211 DOI: 10.1097/dss.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Frieder J, Kivelevitch D, Menter A. Symptomatic hypercalcemia and scarring alopecia as presenting features of sarcoidosis. Proc (Bayl Univ Med Cent) 2018; 31:224-226. [PMID: 29706828 DOI: 10.1080/08998280.2018.1435118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/29/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease most frequently affecting the lungs, lymph nodes, and eyes. Skin involvement occurs in approximately 25% to 35% of cases, with the scalp uncommonly affected. Abnormal calcium metabolism is associated with sarcoidosis and other granulomatous disorders and most commonly presents as hypercalciuria (40%-60%) and, less frequently, hypercalcemia (10%-20%). Symptomatic hypercalcemia is unusual, presenting in <5% of sarcoidosis patients, and rarely results in kidney damage. We report here a case of sarcoidosis presenting with severe symptomatic hypercalcemia (>14 mg/dL, 3.5 mmol/L), scarring alopecia, and acute-on-chronic kidney failure.
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Affiliation(s)
- Jillian Frieder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Dario Kivelevitch
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
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40
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Deng Q, Ding S, Yang S, Huang J. Cutaneous sarcoidosis and secondary open-angle glaucoma in a patient: case report and literature review. An Bras Dermatol 2017; 92:407-409. [PMID: 29186261 PMCID: PMC5514589 DOI: 10.1590/abd1806-4841.20175368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/02/2016] [Indexed: 12/29/2022] Open
Abstract
The current report presents the case of a 41-year-old male patient with a two-month history of asthenopia and plaques in the frontotemporal region. Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure. Skin biopsy demonstrated aa dermal inflammatory infiltrate composed mainly of epithelioid cells and a few multinucleated giant cells, but no obvious lymphocytes. Findings of thorough physical examinations and auxiliary examinations suggested the presence of cutaneous sarcoidosis and secondary open-angle glaucoma. Treatment consisted mainly of oral methylprednisolone. Skin lesions, bilateral hilar, and mediastinal lymphadenopathy resolved completely. Cutaneous sarcoidosis is often accompanied by extracutaneous organ involvement. Dermatologists must be aware of the disease's extracutaneous manifestations to ensure accurate diagnosis for further treatments.
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Affiliation(s)
- Qiancheng Deng
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shu Ding
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shengbo Yang
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
| | - JinHua Huang
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
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41
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Liu KL, Tsai WC, Lee CH. Cutaneous sarcoidosis: A retrospective case series and a hospital-based case-control study in Taiwan. Medicine (Baltimore) 2017; 96:e8158. [PMID: 28984765 PMCID: PMC5738001 DOI: 10.1097/md.0000000000008158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown etiology often involving skin. Studies on cutaneous sarcoidosis and comorbidities are limited. This study is aimed to describe the clinical features of cutaneous sarcoidosis diagnosed in our hospital and to determine the relationships between cutaneous sarcoidosis and comorbidities.This retrospective study evaluates patients with cutaneous sarcoidosis in a tertiary center in Taiwan from 1996 to 2015. The records of 38 patients with cutaneous sarcoidosis were reviewed for clinical characteristics and evaluated by analysis of variance. A 1:4 case-control analysis was conducted with 152 age- and sex-matched controls who underwent biopsy for other benign skin tumors.The male to female ratio was 1:4.4. The average age at diagnosis was 51.7 years. Female patients were on average 13.9 years older than male patients. The correlation of age with gender was statistically significant (P = .037). The most common cutaneous lesions were plaques (47.4%) and confined to the face (71.1%). Of the 38 patients, 26.3% had diabetes mellitus. Age over 40 (P = .014) and female (P = .014) were associated with facial involvement. In the case-control study, a higher percentage of patients with cutaneous sarcoidosis than of control subjects had diabetes mellitus (P = .001), hearing loss (P = .031) and eye diseases (P = .047).The present study demonstrates a striking female predominance and high proportions of facial involvement. Diabetes mellitus, hearing loss, and eye diseases may be associated with Taiwanese patients with cutaneous sarcoidosis.
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42
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Miramontes González JP, Velasco Tirado V, González García P, Sánchez García M, Fidalgo Fernández Á. I Can Not Wear My Sunglasses: An Unusual Sarcoidosis Presentation. Korean J Fam Med 2017; 38:226-228. [PMID: 28775813 PMCID: PMC5541171 DOI: 10.4082/kjfm.2017.38.4.226] [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: 08/12/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022] Open
Abstract
A 39-year-old Caucasian man was referred to University Hospital Salamanca from a primary care unit due to the presence of an erythematous violaceous nodule at the superior portion of his nose. Physical examination indicated that the firm, fixed erythematous violaceous nodule measured approximately 2 cm in diameter and was located inferior to a scar on the nasal bridge. Cutaneous involvement in sarcoidosis occurs in 25% of cases. A wide range of clinical presentations of cutaneous sarcoidosis is recognized. Skin lesions are classified as either non-specific, of which erythema nodosum is the most representative and specific, or as granulomatous, which includes maculopapular nodules, plaques, infiltrated scars, lupus pernio, ulcerations, warty lesions and erythroderma. Scar sarcoidosis is a type of cutaneous sarcoidosis.
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Affiliation(s)
- José Pablo Miramontes González
- Department of Internal Medicine Unit, University Hospital Salamanca, Salamanca, Spain.,IBSAL, Institute Biomedical Research of Salamanca, Salamanca, Spain
| | - Virginia Velasco Tirado
- IBSAL, Institute Biomedical Research of Salamanca, Salamanca, Spain.,Department of Dermatology, University Hospital Salamanca, Salamanca, Spain
| | - Pablo González García
- Department of Internal Medicine Unit, University Hospital Salamanca, Salamanca, Spain.,IBSAL, Institute Biomedical Research of Salamanca, Salamanca, Spain
| | - Marta Sánchez García
- Department of Internal Medicine Unit, University Hospital Salamanca, Salamanca, Spain
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43
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Madureira P, Pimenta S, Cardoso H, Guimarães Cunha R, Costa L. Sarcoidosis: An unusual presentation. REUMATOLOGIA CLINICA 2017; 13:227-229. [PMID: 27068192 DOI: 10.1016/j.reuma.2016.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/01/2016] [Indexed: 06/05/2023]
Abstract
A 35-year-old man presented with a 3-year history of arthralgia and purple coloration of the skin of his fingers and feet. Hand and foot radiography showed cystic bone lesions on phalanges suggestive of sarcoidosis. Lab tests revealed increased liver enzymes. Liver MRI evidenced an enlarged liver and retroperitoneal lymphadenopathy. Histological analysis of the finger skin, lymph nodes and liver demonstrated the presence of granulomas, confirming the diagnosis of sarcoidosis. The patient started prednisolone with rapid improvement of the symptoms. Skin lesions are divided into two groups: specific for sarcoidosis (with granulomas, lupus pernio-like) and nonspecific (without granulomas, erythema nodosum-like). Specific cutaneous lesions usually cause no other symptoms beyond cosmetic changes. Lupus pernio stands out for having distinctive features but, to the best of our knowledge, the simultaneous involvement of both hands and feet has never been reported.
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Affiliation(s)
- Pedro Madureira
- Rheumatology Department, Centro Hospitalar de São João, Porto, Portugal; Rheumatology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Sofia Pimenta
- Rheumatology Department, Centro Hospitalar de São João, Porto, Portugal; Rheumatology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Hélder Cardoso
- Gastrenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | | | - Lúcia Costa
- Rheumatology Department, Centro Hospitalar de São João, Porto, Portugal
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44
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Thi Hong Nguyen C, Kambe N, Kishimoto I, Ueda-Hayakawa I, Okamoto H. Serum soluble interleukin-2 receptor level is more sensitive than angiotensin-converting enzyme or lysozyme for diagnosis of sarcoidosis and may be a marker of multiple organ involvement. J Dermatol 2017; 44:789-797. [DOI: 10.1111/1346-8138.13792] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Naotomo Kambe
- Department of Dermatology; Kansai Medical University; Hirakata Japan
| | - Izumi Kishimoto
- Department of Dermatology; Kansai Medical University; Hirakata Japan
| | | | - Hiroyuki Okamoto
- Department of Dermatology; Kansai Medical University; Hirakata Japan
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45
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Zhao S, Wang Q, Cheng B, Zhu XF. Rare scar sarcoidosis: A case report. Exp Ther Med 2017; 13:1535-1537. [PMID: 28413505 DOI: 10.3892/etm.2017.4123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/01/2016] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old female patient presenting with swelling and subcutaneous nodule formation localized to the knee scars over a two-month period is presently reported. Dermatological examinations found erythematous swelling and small papules on the patient's knee scars, along with subcutaneous nodules beneath and around the scars. Computer tomography of the chest region identified multiple obscure tubercles in the lungs and swollen lymph nodes in the hilum pulmonis and mediastinum. Skin biopsy revealed multiple non-caseating granulomas, which had infiltrated the dermis. The patient was diagnosed with scar sarcoidosis as a result of these observations. The onset of scar sarcoidosis is rare and, therefore, not well understood; however, inflammatory alterations in preexisting scars may be important indicators for disease onset.
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Affiliation(s)
- Sha Zhao
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Qin Wang
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Beibei Cheng
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Xiao-Fang Zhu
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
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46
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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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47
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Mevius H, Quax RA, Alsma J. Man With Necrotizing Ulcers on the Leg. Ann Emerg Med 2016; 68:244-51. [DOI: 10.1016/j.annemergmed.2016.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Indexed: 11/29/2022]
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48
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Frikha F, Turki C, Salah RB, Damak C, Loukil H, Snoussi M, Bahloul Z. Des nodules sous-cutanés des avant-bras. Rev Med Interne 2016; 37:572-3. [DOI: 10.1016/j.revmed.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
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49
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Albers BK, Sluzevich JC, Garner HW. Sarcoidosis: radiographic manifestations in the nails and distal phalanges. Skeletal Radiol 2016; 45:717-21. [PMID: 26768259 DOI: 10.1007/s00256-015-2326-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/09/2015] [Accepted: 12/28/2015] [Indexed: 02/02/2023]
Abstract
Sarcoidosis is a granulomatous disease which can affect multiple organ systems. Clinical and radiologic manifestations depend on the organ system involved and the chronicity of disease. Nail involvement in sarcoidosis is rare, but is clinically relevant as it indicates chronic systemic disease. Nail abnormalities can be identified radiographically, and when seen in patients with known or suspected sarcoidosis, should prompt careful evaluation of the underlying bone for osseous involvement. We describe a case of sarcoidosis with radiographic findings in the nails and distal phalangeal tufts, which were indicative of nail and osseous sarcoid involvement and strongly supported the presence of chronic systemic disease. Although the nail findings resolved clinically and on radiographs after treatment, the osseous findings showed only minimal improvement. To our knowledge, the radiographic findings of nail sarcoidosis have not been previously addressed in the literature.
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Affiliation(s)
- Brittany K Albers
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Jason C Sluzevich
- Department of Dermatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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50
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Noriega L, Criado P, Gabbi T, Avancini J, Di Chiacchio N. Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases. Skin Appendage Disord 2015; 1:87-90. [PMID: 27170939 DOI: 10.1159/000435923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/12/2015] [Indexed: 11/19/2022] Open
Abstract
The most commonly seen nail change in sarcoidosis, often associated with chronic systemic disease, is onychodystrophy. Imaging of hands, feet and chest is of paramount importance when nail sarcoidosis is suspected, for evaluation of bone cysts and pulmonary involvement, respectively. We report 2 cases of sarcoidosis that developed nail involvement - one with pulmonary disease, and the other without any evidence of systemic involvement, which is very rare.
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Affiliation(s)
- Leandro Noriega
- Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo, Brazil
| | - Paulo Criado
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tatiana Gabbi
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - João Avancini
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nilton Di Chiacchio
- Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo, Brazil
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