Polymorphous cutaneous and chronic multisystem sarcoidosis

Area of Science:

• Dermatology
• Pulmonology
• Rheumatology

Background:

• Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
• Cutaneous involvement is common in sarcoidosis and can present with diverse morphologies.
• The differential diagnosis for skin lesions in sarcoidosis is broad, mimicking other dermatological conditions.

Observation:

• A 56-year-old woman presented with a decade-long history of sarcoidosis involving skin, eyes, bones, heart, and lungs.
• Her cutaneous manifestations included subcutaneous nodules, annular plaques on the shins, and erythema nodosum-like lesions.
• This patient exhibited three distinct types of skin lesions simultaneously.

Findings:

• The simultaneous presence of subcutaneous nodules, annular plaques, and erythema nodosum-like lesions is highly unusual in sarcoidosis.
• Histologically specific cutaneous sarcoidosis lesions, particularly erythema nodosum-like ones, were noted.
• The polymorphous nature of the cutaneous findings complicated the diagnosis.

Implications:

• This case emphasizes the importance of considering sarcoidosis in patients with multiple, diverse skin lesions.
• Recognizing unusual cutaneous presentations is crucial for timely diagnosis and management of systemic sarcoidosis.
• Further research into the pathogenesis of varied cutaneous manifestations in sarcoidosis may be warranted.