Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2505-2512
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2505
Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature
Raman Mehrzad, Julia Festa, Reena Bhatt
Raman Mehrzad, Julia Festa, Reena Bhatt, Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Author contributions: All authors added work and value to the manuscript.
Informed consent statement: Informed consent was obtained from the patient prior to the writing of this case report.
Conflict-of-interest statement: The authors declare there is no conflict of interest
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Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Raman Mehrzad, MD, Academic Fellow, Doctor, Staff Physician, Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, 235 Plain St, Providence, RI 02903, United States.
Telephone: +1-774-2400060
Received: March 26, 2019
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.

Keywords: Subcutaneous sarcoidosis, Upper extremity, Granulomatous disease, Case report

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.