Sarcoidosis with cutaneous granulomatous vasculitis

Abstract

Ulceration of non-caseating granulomas is a rare cutaneous presentation of sarcoidosis. Granulomatous vasculitis is classically associated with Wegener's granulomatosis, lymphomatoid granulomatosis or Churg-Strauss syndrome. It is also commonly noted in pulmonary sarcoidosis, but has seldom been reported in cutaneous sarcoidosis, particularly the ulcerative variant. We present a rare case of sarcoidosis with multiple purpuric leg ulcers showing a granulomatous vasculitis histologically.

Cutaneous sarcoidosis in southern Taiwan: clinicopathologic study of a series with high proportions of lesions confined to the face and angiolupoid variant

“…The lung (57%) and lymph nodes (65%) are the two most commonly affected extra‐cutaneous organs, followed by the eye (43%). However, erythema nodosum was very uncommon in several studies of cutaneous sarcoidosis reported from Taiwanese and other Asian countries 11–17,19,22–31 . In the present study, no case of erythema nodosum was diagnosed.…”

“…Once considered rare in Taiwan, sarcoidosis has been increasingly diagnosed and reported in the last two decades 11,13–16,19,22–30 . About 331 Taiwanese cases (our 37 cases of the present series included), have been reported since 1960, mostly after 1992 11–16,19,22–30 . Of these, 107 cases were reported by dermatologists, 115 cases by ophthalmologists and 109 cases by internists.…”

“…However, erythema nodosum was very uncommon in several studies of cutaneous sarcoidosis reported from Taiwanese and other Asian countries. [11][12][13][14][15][16][17]19,[22][23][24][25][26][27][28][29][30][31] In the present study, no case of erythema nodosum was diagnosed.…”

“…11,[13][14][15][16]19,[22][23][24][25][26][27][28][29][30] About 331 Taiwanese cases (our 37 cases of the present series included), have been reported since 1960, mostly after 1992. [11][12][13][14][15][16]19,[22][23][24][25][26][27][28][29][30] Of these, 107 cases were reported by dermatologists, 115 cases by ophthalmologists and 109 cases by internists. Cutaneous manifestations were recorded in 151 cases (46%); 142 patients (43%) had sarcoidal skin lesions and 9 (3%) had erythema nodosum.…”

A diagnosis that will go down in history

“…Cutaneous sarcoidosis is known for its protean clinical presentations, including erythema nodosum, macules, papules and plaques, scar sarcoidosis, ichthyosis, Darier–Roussy lesions, alopecia and onychodystrophy 4 . Physicians should be aware of cutaneous signs of sarcoidosis because they lend themselves to biopsy facilitating diagnosis, many have prognostic significance, and they can impose a significant burden on quality of life 5 …”