Two cases of sarcoidosis presenting with skin nodules as the first manifestation

We report two cases of sarcoidosis presenting with skin nodules as the first manifestation, without prominent respiratory symptoms. Chest CT showed multiple pulmonary nodules and lymphadenopathy. Case 1, a 47-year-old female, presented with nodules on the elbows and fingers. Dermatological examination revealed demarcated, asymptomatic red and skin-colored nodules on the right elbow, and the index finger and the little finger of the left hand, sized 0.3 to 0.9 cm in diameter. Histopathology of the left pinky finger showed normal epidermis and epithelia granuloma with fibrous encapsulated naked tubercles in the dermis. Chest CT revealed bronchitis and multiple nodules in the both lungs, mediastinal and hilar lymphadenopathy. The diagnosis was sarcoidosis. Case 2, a 44-year-old female, complained of a 3-month history of nodules on the left lower limb. Dermatological examination showed two dark red and skin-colored nodules, sized 2.0 cm×2.0 cm and 3.0 cm×2.0 cm, respectively, on the anterior tibia of the left lower leg. A demarcated asymptomatic skin-colored nodule was observed on the posterior left lower leg. Histopathology of the left shin revealed mild epidermal hyperplasia and superficial dermal infiltrates of epithelioid cells and multinucleated giant cells. Chest CT revealed multiple nodules in the lower lobe of the left lung, upper and middle lobes of the right lung, mosaic perfusion of both lungs, a few fibers and calcifications in the middle and lower lobes of the right lung, mediastinal lymphadenopathy with calcification. Patients was diagnosed with sarcoidosis. Both patients were treated with oral prednisone acetate at 30 mg/d for 2 months, followed by a gradual reduction in glucocorticoid dose. No new rash was found after one-year follow-up.