| Introduction: |
| A 29-year-old Afro-American woman was evaluated for an 8 month history of cough, productive of yellow sputum, 90 pound weight loss and several asymptomatic facial lesions present for six months. |
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| History: |
| Her history was notable for asthma, pneumonia (diagnosed twice in the past year), renal disease, intravenous drug use, two incidents of endocarditis, and hepatitis C. She was HIV negative and had a negative PPD test. The asympotmatic bumps on her face first appeared 6 months earlier and had been gradually increasing in size and number.
She had a 10 pack-year tobacco history, and her family history was positive for an uncle with sarcoidosis.
On physical exam, lungs had bilateral wheezing, but were otherwise clear to auscultation.
Chest radiograph and CT scan were suspicious for mild mediastinal adenopathy and CT revealed nodules one cm in diameter in her left upper and lower lobes.
Pulmonary function tests showed moderate obstructive and restrictive ventilatory defects and a severe diffusioion defect
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| Clinical
Presentation: |
| The patient appeared fatigued but was in no acute distress. Examination of the lungs revealed bilateral wheezing although she was noted to be breathing comfortably.
She had multiple 1 cm annular violaceous plaques with indurated borders and depressed centers scattered on the forehead, cheeks and nasal bridge. The nasal mucosa, oral mucosa, gingivae and tongue were normal, and there was no evidence of adenopathy or lacrimal gland hyperplasia
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| Pathology: |
| Histologic examination revealed numerous granulomas composed of epithelioid and multinucleated histiocytes. Multiple giant cells contained non-polarizable material.
Acid fast bacilli flourochrome stain and cultures for fungus and mycobacteria were negative. |
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| Question
1: |
| What are the typical cutaneous lesions of sarcoidosis? |
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| Question
2: |
| What other cutaneous lesions have been reported in association with sarcoidosis? |
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| Question
3: |
| What is the differential diagnosis for this patient? |
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| Question
4: |
| What is the appropriate treatment? |
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