[Scalp and leg ulcerations revealing systemic sarcoidosis]

Sarcoidosis is a multisystem disorder. Skin injury can have a wide range of semiologies. Ulcerated forms have rarely been described.

A 56-year-old woman was operated on for a scalp mass. The pathological study shows tuberculoid granulomas with caseous necrosis of the right temporalis muscle. Two years later, she consulted for ulcerations of the scalp and right leg. Histological examination of the scalp lesion and a back lesion showed gigantocellular granulomas without caseous necrosis. Thoraco-abdomino-pelvic CT scan revealed hilar and abdominopelvic lymphadenopathy. On brain magnetic resonance imaging, signs of myositis of the right temporalis muscle involvement were noted. The diagnosis of ulcerated multisystem sarcoidosis was made. A spectacular improvement was noted after seven months of treatment with systemic prednisone, without recurrence after three years.

We report an original observation of cutaneous ulcerations revealing multisystemic sarcoidosis. Diagnosis of this rare form relies on skin biopsy and exclusion of other cutaneous granulomatoses. The evolution of ulcerative sarcoidosis is usually satisfactory with the usual treatments of sarcoidosis.