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Subcutaneous sarcoidosis with underlying intramuscular granuloma.

Ohashi T, Yamamoto T - Indian J Dermatol (2015 Jan-Feb)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Fukushima Medical University, Fukushima, Japan. E-mail: toyamade@fmu.ac.jp.

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Sir, Sarcoidosis is a systemic granulomatous disorder of unknown etiology... We report herein a rare case presenting with subcutaneous sarcoidosis on the lower legs, in which biopsy specimen contained underlying intramuscular sarcoidal granuloma... Furthermore, granulomatous lesions with multinuclear giant cells were detected in the muscle in the same specimen [Figure 2c]... She did not have any symptoms of myopathy... Subcutaneous sarcoidosis is closely associated with systemic manifestations, such as lung involvement, uveitis, lymphadenopathy, arthritis, mucositis, dactylitis, neurological and renal involvement, and hepatosplenomegaly... Symptomatic sarcoid myopathy is seen in only 0.5-5% of patients with sarcoidosis, whereas asymptomatic involvement can be detected in 25-75%... Nodular form is quite rare, and patients present with painful nodules on the muscle of the extremities... To make a diagnosis of sarcoidosis, it is necessary to confirm sarcoid granuloma from different organs... In the present case, myopathy was not accompanied, and detection of muscle granuloma may be coincidental... To date, only limited cases of sarcoidosis with musculocutaneous involvement have been reported... However, it might be better to carry out skin biopsy including the underlying muscle, when sarcoidosis is suspected.

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Related in: MedlinePlus

Subcutaneous induration on the anterior lower leg
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Figure 1: Subcutaneous induration on the anterior lower leg

Mentions: A 57-year-old female was diagnosed with sarcoidosis, initially presented with subcutaneous nodule on the buttock. A biopsy was taken at the department of orthopedic surgery, which revealed subcutaneous epithelial cell granuloma without caseation necrosis. Laboratory examination showed increased serum levels of angiotensin-converting enzyme (ACE) (48.2 IU/L; normal, 7-25) and positive antinuclear antibody (1:160, homogenous), whereas specific antibodies (SS-A, SS-B, Sm, Scl-70) were all negative. Blood chemistry data including liver, renal and creatine phosphokinase were within normal ranges. Lung computed tomography (CT) indicated multiple small nodules and hilar lymphadenopathy. Ophthalmologic and cardiac examinations were normal. On physical examination at the initial visit to our department, she had scar sarcoid on the knees, papular lesions on the elbow. Also, she developed subcutaneous tenderness on the lower legs [Figure 1]. A biopsy specimen showed sarcoidal granuloma in the subcutaneous tissues [Figure 2a and b]. Furthermore, granulomatous lesions with multinuclear giant cells were detected in the muscle in the same specimen [Figure 2c]. She did not have any symptoms of myopathy.


Subcutaneous sarcoidosis with underlying intramuscular granuloma.

Ohashi T, Yamamoto T - Indian J Dermatol (2015 Jan-Feb)

Subcutaneous induration on the anterior lower leg
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318048&req=5

Figure 1: Subcutaneous induration on the anterior lower leg
Mentions: A 57-year-old female was diagnosed with sarcoidosis, initially presented with subcutaneous nodule on the buttock. A biopsy was taken at the department of orthopedic surgery, which revealed subcutaneous epithelial cell granuloma without caseation necrosis. Laboratory examination showed increased serum levels of angiotensin-converting enzyme (ACE) (48.2 IU/L; normal, 7-25) and positive antinuclear antibody (1:160, homogenous), whereas specific antibodies (SS-A, SS-B, Sm, Scl-70) were all negative. Blood chemistry data including liver, renal and creatine phosphokinase were within normal ranges. Lung computed tomography (CT) indicated multiple small nodules and hilar lymphadenopathy. Ophthalmologic and cardiac examinations were normal. On physical examination at the initial visit to our department, she had scar sarcoid on the knees, papular lesions on the elbow. Also, she developed subcutaneous tenderness on the lower legs [Figure 1]. A biopsy specimen showed sarcoidal granuloma in the subcutaneous tissues [Figure 2a and b]. Furthermore, granulomatous lesions with multinuclear giant cells were detected in the muscle in the same specimen [Figure 2c]. She did not have any symptoms of myopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Fukushima Medical University, Fukushima, Japan. E-mail: toyamade@fmu.ac.jp.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Sarcoidosis is a systemic granulomatous disorder of unknown etiology... We report herein a rare case presenting with subcutaneous sarcoidosis on the lower legs, in which biopsy specimen contained underlying intramuscular sarcoidal granuloma... Furthermore, granulomatous lesions with multinuclear giant cells were detected in the muscle in the same specimen [Figure 2c]... She did not have any symptoms of myopathy... Subcutaneous sarcoidosis is closely associated with systemic manifestations, such as lung involvement, uveitis, lymphadenopathy, arthritis, mucositis, dactylitis, neurological and renal involvement, and hepatosplenomegaly... Symptomatic sarcoid myopathy is seen in only 0.5-5% of patients with sarcoidosis, whereas asymptomatic involvement can be detected in 25-75%... Nodular form is quite rare, and patients present with painful nodules on the muscle of the extremities... To make a diagnosis of sarcoidosis, it is necessary to confirm sarcoid granuloma from different organs... In the present case, myopathy was not accompanied, and detection of muscle granuloma may be coincidental... To date, only limited cases of sarcoidosis with musculocutaneous involvement have been reported... However, it might be better to carry out skin biopsy including the underlying muscle, when sarcoidosis is suspected.

No MeSH data available.


Related in: MedlinePlus