Acute Vitiligo Repigmentation in the Setting of Suspected Pulmonary Sarcoidosis

Background: Sarcoidosis is a noncaseating granulomatous disease that predominately occurs in the lungs. Vitiligo is the most common depigmentation disorder worldwide. Both diseases are autoimmune-mediated, suggesting that one could have implications for the other. However, relatively few reports have been published about patients presenting with coinciding symptoms of the 2 diseases. We report the case of a patient who presented with focal repigmentation of vitiligo with suspected pulmonary sarcoidosis. Case Report: A 63-year-old female with a medical history of diffuse vitiligo reported to the emergency department with the chief complaint of right lower extremity weakness and numbness for 1 week. She reported that she had had a chronic productive cough for the prior 4 to 6 months and had unintentionally lost 50 to 60 pounds in the prior 3 months. At that time, she began to notice numerous hyperpigmented macules and patches on both forearms and her face. Chest x-ray and chest computed tomography demonstrated bilateral hilar and mediastinal lymph node enlargement with multiple bilateral pulmonary nodules. Cytology and flow cytometry were negative for evidence of B- or T-cell lymphoproliferative disorder with evidence of granulomatous inflammation. Conclusion: This clinical presentation suggests a potential interplay between 2 unique disease processes. While both vitiligo and sarcoidosis share common autoimmune etiologies, little data are available about management when they coincide. This case highlights a patient with 2 seemingly distinct clinical manifestations that could yield further clinical information in the management of both diseases separately and together.