Red Nose, Deeper Cause: Lupus Pernio as A Sentinel Sign of Systemic Sarcoidosis

Lupus pernio (LP) is a rare but distinctive manifestation of cutaneous sarcoidosis, often reflecting systemic involvement, particularly of the upper respiratory tract. We report the case of a 53-year-old woman presenting with an asymptomatic violaceous plaque on the nose evolving over eight months, associated with nasopharyngeal symptoms. Imaging revealed a pseudotumoral thickening of the posterior nasopharyngeal wall, and biopsies confirmed the diagnosis of sarcoidosis with concurrent cutaneous and nasopharyngeal involvement. Further systemic workup revealed additional salivary gland and lymph node involvement. Treatment with systemic and topical corticosteroids combined with hydroxychloroquine led to significant clinical improvement. This case underscores the importance of recognizing LP as a sentinel sign of systemic sarcoidosis and highlights the need for early diagnosis, multidisciplinary evaluation, and appropriate therapy to prevent aesthetic sequelae and systemic progression.