Diffuse Papular Eruption With Swelling of Joints in a Preschooler

Abstract

A 4-year-old black boy presented with polyarthritis and dermatitis. The mother had noticed swelling of the patient's joints over the preceding 2 to 3 years, although the child never complained of joint pain. At age 9 months, a chronic, fine papular rash, which persisted, developed (Fig 1).On physical examination, the child was small for his age, with a diffuse papular rash and swollen, nontender joints with a boggy synovium involving the wrists, elbows, ankles, and knees bilaterally (Fig 2).Several shotty cervical lymph nodes, the edge of the liver at the right costal margin, and the tip of the spleen could be palpated. Pulmonary and cardiac examinations showed normal findings.Ophthalmologic examination revealed uveitis and cataract formation bilaterally. More significant involvement of the right eye was present.Hematologic and chemistry profiles showed normal findings. The erythrocyte sedimentation rate was 52 mm/h. Antinuclear antibody and rheumatoid factors were negative.The chest roentgenogram was normal. The roentgenograms of the cervical spine, pelvis, ankle, wrists, and feet showed diffuse osteoporosis. The skin test for tuberculosis was nonreactive.Biopsy specimens of the skin (Fig 3) and the synovium were obtained.

Sarcoidosis in a Preschooler with Only Skin and Joint Involvement

“…A different clinical picture was detected in children less than 4–5 years of age. At that age skin rash, uveitis, and arthritis were found to be more common (4,6,9) and intrathoracic involvement was absent in this group (7,8,10,11), as in our patient. The rash was usually macular and papular, started peripherally, then became generalized and sometimes preceded the other manifestations by several months (6,7).…”

“…The rash was usually macular and papular, started peripherally, then became generalized and sometimes preceded the other manifestations by several months (6,7). Joint manifestations often started months after the onset of rash (11). In younger children, besides macular and papular lesions, there could be reddish‐brown confluent plaques, eczema‐like lesions, or a lichen nitidus‐like eruption (1,5,8,11).…”

“…Joint manifestations often started months after the onset of rash (11). In younger children, besides macular and papular lesions, there could be reddish‐brown confluent plaques, eczema‐like lesions, or a lichen nitidus‐like eruption (1,5,8,11). Involvement of the eye sometimes produced severe disability and permanent damage with loss of vision.…”

“…Most patients described in the literature with sarcoidosis have no abnormalities seen on radiographs of the joints. However, there are some patients reported who had osteoporosis after years of joint involvement (11). The evidence of erosive disease or osteoporosis with radiographic examination, which would be expected in rheumatoid disease, was not detected in our patient.…”

“…Involvement of the eye sometimes produced severe disability and permanent damage with loss of vision. Anterior uveitis was the most common manifestation (5,11). Posterior synechiae, optic atrophy, miliary retinitis, and granulomas of the conjunctiva and optic nerve have also been described (7).…”