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[Sarcoid Granulomas Over Scars: Beyond Sarcoidosis]
Francisca Morgado1, Mariana Batista1, José Carlos Cardoso1
1Serviço de Dermatologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
Acta Medica Portuguesa
|December 6, 2021
Summary
Differentiating sarcoidosis from sarcoid-like reactions is challenging. Patch testing is crucial, as demonstrated in a case where palladium allergy caused granulomatous contact dermatitis mimicking sarcoidosis.
Area of Science:
- Dermatology
- Immunology
- Pathology
Background:
- Sarcoid granulomas are observed in various conditions, complicating the distinction between sarcoidosis and sarcoid-like reactions.
- Cutaneous manifestations, such as erythematoviolaceous papulonodular lesions, can present diagnostic challenges.
Purpose of the Study:
- To investigate a case of granulomatous skin lesions on the ears.
- To differentiate between cutaneous sarcoidosis and granulomatous contact dermatitis.
Main Methods:
- Skin biopsy for histopathological examination.
- Assessment of angiotensin-converting enzyme (ACE) levels.
- Epicutaneous patch testing for contact allergens.
Main Results:
- Histopathology revealed sarcoid and focal tuberculoid granulomas.
- Systemic sarcoidosis was ruled out; ACE levels showed a slight increase.
- Patch testing confirmed hypersensitivity to palladium and nickel.
Conclusions:
- The patient was diagnosed with granulomatous contact dermatitis due to palladium sensitization from ear piercings.
- Sarcoid granuloma formation can indicate either sarcoidosis or a sarcoid-like reaction.
- Patch testing is essential for accurate diagnosis in such cases.
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