Multiple Plantar Swellings as the Presenting Sign of a Systemic Disease: Answer

Abstract

ANSWERPlantar sarcoidosis, as a primary manifestation of asymptomatic systemic disease, in the form of stage I pulmonary sarcoidosis (pulmonary lymphadenopathy alone). DISCUSSIONSarcoidosis is a chronic, inflammatory, multisystem, disorder that is characterized by noncaseating granulomas. Sarcoidosis predominantly affects the lungs, but the skin is cited as the second most frequently involved organ, occurring in 25%-30% of patients with systemic sarcoidosis. 1 Females have a higher incidence of sarcoidosis than males. 2 The mean age at diagnosis is 47.31 6 15.46 years. 3 Hypercalcemia and hypercalciuria are reported in the significant number of sarcoidosis patients that was estimated to be 1.8% and 18.8% of patients, respectively, and they were considered as potential biomarkers for disease severity and activity. 4 Skin findings are often the initial presenting sign of sarcoidosis. 5 Skin sarcoidosis is one of the great imitators in dermatology. 6 There are "specific" and "nonspecific" findings of cutaneous sarcoidosis, based on the presence or absence of characteristic sarcoid granulomas on histopathological examination. Specific cutaneous sarcoidosis findings include papules, papulonodules, plaques, lupus pernio, and subcutaneous nodules. Less common cutaneous findings include ichthyosiform, atrophic, ulcerative, mucosal, erythroderma, alopecia, and nail sarcoidosis. 1 Plantar involvement in sarcoidosis is very rare, and only 3 cases have been reported in the literature. [6][7][8] In 2 of the reported cases, there were unilateral plantar involvement and they were associated with asymptomatic systemic disease in the form of stage II pulmonary sarcoidosis (nodal and parenchymal lung involvement). 6,7 While in the third case, the