| Diagnosis: | ||||||
| Based on clinical findings and histologic examination, the patient was diagnosed with sarcoidosis. Sarcoidosis is a chronic granulomatous inflammatory disorder affecting multiple organs. Clinical manifestations most commonly include pulmonary infiltrates, constitutional symptoms, lymphadenopathy, uveitis, and skin lesions. Cutaneous lesions of sarcoidosis are diverse. Common lesions include erythema nodosum, lupus pernio, indurated papules and plaques, subcutaneous nodules, and infiltrated scars. Rarely cutaneous sarcoid manifests as psoriasiform, icthyosiform, erythrodermic, ulcerative, lichenoid, vasculitic, verrucous, and papillomatous eruptions. | ||||||
| Lab Tests: | ||||||
| Lab Tests: Gamma globulin 3.3, ESR 86, LDH 379, ANA +, WBC 3750, Hct 30.2, Plt 206 Creatinine 1.3, BUN 16, Calcium: 8.6 Albumin 2.3, Total bilirubin 1.5, ALT 19, AST 42, Alkaline Phosphatase normal | ||||||
| Differential: | ||||||
| The differential diagnosis for this patient also included deep fungal infection, tuberculid reaction, and granuloma annulare. This woman's pulmonary symptoms, the morphology of the cutaneous lesions, and the histopathology fit best with sarcoidosis. | ||||||
| Treatment: | ||||||
| In patients with systemic symptoms, a tapering course of oral corticosteroids is the treatment of choice. In patients with lesions limited to the the skin topical and/or intralesional steroids may be adequate therapy. When an individual is diagnosed with sarcoidosis, a thorough medical examination and multidisciplinary approach is required to assess systemic disease. In addition to a full lung evaluation, patients require input from ophthalmology, otolaryngology, and hematology, and possibly cardiology, gastroenterology and rheumatology. Further studies should include an electrocardiogram, renal and hepatic function tests, and other chemistries. | ||||||
| Summary: | ||||||
| In summary, this patient had sarcoidosis with severe pulmonary diseae, cutaneous plaques and renal disease. Although her cutaneous plaques were somewhat unusual for sarcoidosis, the histopathology was characteristic. Biopsy of suspicious skin lesions should always be considered when sarcoidosis is considered. | ||||||
| References | ||||||
| 1. Braunwald et al. Harrison's Principles of Internal Medicine. McGraw-Hill: 2001, 1969-1974 | ||||||
| 2. Fitzpatrick et al., Dermatology in General Medicine. 1993 2221-2228 | ||||||
| 3. Gould,KP; Callen JP; eMedicine Journal. August 2, 2001, Volume 2, Number 8, http://www.emedicine.com/derm/topic381.htm | ||||||
| 4. Rook, Wilkinson,and Ebling, Textbook of Dermatology. ed Champion and Burton, Blackwell Scientific Publications, 1050-1051, 2383-2406 | ||||||
