An Unusual presentation of Cutaneous Sarcoidosis in a Nigerian: A case report

Background: Sarcoidosis is an idiopathic disorder which present with different manifestation. This is an unusual case of cutaneous sarcoidosis with extensive polymorphic lesions on the skin as the only organ involved. Case Report: Mrs. A.O, a 28 year old house-wife presented with a one year history of progressive itchy, reddish, raised skin rashes for one year. Lesions were initially localized to the chest and limbs but subsequently involved the whole body including the palms and soles. No history of fever or weight loss. On examination, she had generalized erythematous, annular and arcuate plaques with areas of active edges involving the whole body including the palms and soles. Healed lesions were atrophic and hyperpigmented (Figure 1). No mucosal involvement. Her chest radiograph, FBC, ESR, LFT, serum Calcium, ACE levels (20U/L) and ECG were normal, while her Mantoux and Gene expert test was negative. Biopsy of the lesion showed dermal infiltrates, composed of epithelioid histocytes disposed in nodules as well as multinucleated giant cells of langhans and foreign body types features consistent with cutaneous annular sarcoidosis (Figure 3 and 4). She was placed on systemic steroids followed by topical steroids and made significant improvement. (figure 2) Conclusion: Sarcoidosis is not common in our environment and cutaneous manifestation as the sole presentation is even rarer. We report one such case with skin as the sole organ affected and equally of interest is the extensive nature of the lesions observed.