Extrathoracic sarcoidosis in a Chinese man presenting with multiple, large plaques and tumors

We report an unusual case of tumorous sarcoidosis in a 42-year-old Chinese man with extrathoracic sarcoidosis. He presented with multiple large plaques and tumors on the neck and extremities of a nine-year duration. Because of the atypicality of the cutaneous manifestation, the lack of intrathoracic lesions and the rarity of sarcoidosis in Taiwan, the case remained undiagnosed for nine years despite numerous examinations and tests. A subsequent skin biopsy revealed sarcoidal granulomas. The detection of cytoplasmic birefringent inclusions in the granulomas led to the final diagnosis. Originally thought to be foreign bodies, the inclusions were proven to be calcium oxalate by x-ray microanalysis and calcium oxalate stain. Lymph node and liver biopsies confirmed the diagnosis. The skin lesions in this case may have been precipitated by frequent harsh scrubbing to clean the skin. Sarcoidosis should be considered in the differential diagnosis in patients presenting with multiple cutaneous tumors. This case also illustrates that detection of calcium oxalate inclusions in granulomas, while not specific, can serve as a valuable clue in the diagnosis of cutaneous sarcoidosis.