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Cutaneous sarcoidosis masquerading as relapsed borderline tuberculoid leprosy?
1Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Summary
A rare subcutaneous nodule presentation of cutaneous sarcoidosis is described. This case highlights diagnostic challenges, particularly differentiating from leprosy, and confirms sarcoidosis via histopathology.
Area of Science:
- Dermatology
- Immunology
- Pathology
Background:
- Cutaneous sarcoidosis is a multisystem granulomatous disease with diverse clinical presentations.
- Accurate diagnosis can be challenging, often requiring differentiation from other granulomatous conditions like leprosy.
- Leprosy treatment, such as World Health Organization multidrug therapy (MDT), may precede sarcoidosis diagnosis.
Observation:
- The patient initially presented with features suggestive of borderline tuberculoid leprosy, progressing to borderline lepromatous leprosy.
- The patient completed a full 2-year course of World Health Organization multidrug therapy (MDT) for leprosy.
- Clinical findings included bilateral hilar lymphadenopathy on chest X-ray and cutaneous anergy (negative Mantoux, candidin, and trichophytin skin tests).
Findings:
- Histopathology was crucial in confirming the diagnosis of sarcoidosis.
- The presence of a subcutaneous nodule represents a rare clinical manifestation of cutaneous sarcoidosis.
Implications:
- This case underscores the importance of considering sarcoidosis in patients with atypical presentations or those previously treated for other granulomatous diseases.
- Recognizing rare cutaneous sarcoidosis variants like subcutaneous nodules is essential for appropriate patient management.
- Diagnostic algorithms should incorporate histopathology for definitive sarcoidosis diagnosis, especially when clinical features overlap with other conditions.