Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2505
Peer-review started: March 28, 2019
First decision: June 17, 2019
Revised: July 25, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: September 6, 2019
Sarcoidosis is a granulomatous disease of unknown etiology that most often impacts the lungs. Cutaneous manifestations of sarcoidosis are seen among 9%-37% of patients. Subcutaneous sarcoidosis is a rare presentation of cutaneous sarcoidosis with estimates of frequency ranging from 1.4%-16%. To date, very few articles and case reports have been written about this subject. In this paper, we describe a case of subcutaneous sarcoidosis and perform a review of the literature to determine if there are commonalities among patients who present with subcutaneous sarcoidosis.
A 38-year-old female, with a past medical history of arthritis and recurrent nephrolithiasis, presents with an 8-mo history of 4 firm, asymptomatic, skin-colored nodules on her left and right upper extremities and neck. Needle biopsy and post-excisional pathology report both revealed well-formed, dense, non-caseating granulomas localized to the subcutaneous tissue. Chest computed tomography revealed mild mediastinal lymphadenopathy. A diagnosis of subcutaneous sarcoidosis was made, and the lesions were surgically removed.
Commonalities among patients presenting with subcutaneous sarcoidosis include: middle-aged female, lesions localizing to the upper or lower limbs, lymphadenopathy or pulmonary infiltration on chest imaging, elevated serum angiotensin-converting enzyme.
Core tip: Recognizing patterns of subcutaneous sarcoidosis is important for hand surgeons and other surgical specialties that do not commonly see this patient population in order to rapidly identify and diagnose a disease that has extra-cutaneous manifestations and can lead to greater morbidity and mortality when not diagnosed or treated early.