1/69. Treatment of cutaneous sarcoidosis using phonophoresis.sarcoidosis is a multiple-system disorder of unknown origin characterized histologically by epithelioid granulomas with little or no necrosis. We describe a 32-year-old female patient with a history of systemic sarcoidosis and common variable immunodeficiency with recurrent, multiple, soft, erythematous and violaceous nodules on the back of her left hand. Her lesions responded to phonophoresis after unsuccessful treatment with topical and intralesional corticosteroids. However, nodules appeared on other parts of her body after phonophoresis was stopped, which suggests that phonophoresis had a localized rather than systemic effect.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
2/69. Annular vasculitis in association with sarcoidosis.We report a case of cutaneous vasculitis with annular features in association with sarcoidosis. A 36-year-old woman presented with fever, polyarthralgias, erythema nodosum, bilateral hilar lymphadenopathy, and induration of a long-standing scar on the face. In addition, she developed annular, erythematous, and purpuric patches over her thighs and buttocks that were histologically characterized by a small vessel leukocytoclastic vasculitis. The presence of circulating immune complexes in the early stages of sarcoidosis might be related to the occurrence of the vascular damage.- - - - - - - - - - ranking = 93.020801677437keywords = erythema nodosum, nodosum, erythema (Clic here for more details about this article) |
3/69. sarcoidosis presenting as nail dystrophy.A 45-year-old woman was referred to the dermatology clinic for assessment of "refractory onychogryphosis." She had a 3-year history of lesions involving distal phalanges of the first and third of her left foot. Initially she described periungual erythema and swelling. Three weeks later she noted a whitish growth and thickening of her third toenail. X-ray films of the digit were reported as normal. Several months later the same changes occurred in her great toe. These lesions were asymptomatic. There was no history of trauma. Numerous fungal cultures were negative. No light microscopic examinations were undertaken. She had a trial of both topical and systemic terbinafine of 3-months duration with no clinical improvement. Several clinical opinions were obtained from two dermatologists, a surgeon, and a chiropodist. Past medical history of note was significant for tubal ligation, cervical cancer, and chronic sinusitis. The latter condition in retrospect was thought to be secondary to sarcoidosis. physical examination revealed periungual violaceous discolouration of the first and third toes of the left foot. There was evidence of significant nail changes including dystrophy, onycholysis, and hyperkeratosis (Fig. 1). The fingernails were normal. There were no other skin abnormalities. A punch biopsy of the tip of the third toe showed granulomatous inflammation. There was evidence of hyperkeratosis, exocytosis, and a dense infiltrate composed of collections of histiocytes and a few giant cells forming granulomas (Fig. 2). Repeat x-ray films of the foot showed soft tissue swelling of the first and third digits. There was bony resorption in the distal phalanges with a lacey trabecular pattern compatible with sarcoidosis (Fig. 3). Chest x-ray films revealed marked hilar adenopathy. The patient was sent to a respirologist who concurred with the diagnosis of sarcoidosis. Further investigations included a low serum calcium of 2.07 mmol/L, serum ACE of 70 U/L (upper limit of normal is 75), Wintrobe erythrocyte sedimentation rate (ESR) of 10 mm per hour, thyroid stimulating hormone concentration of 0.65 mU/L, and a urinary calcium excretion rate that was elevated at 7.3 mmol/day. Pulmonary function tests were unremarkable. The patient was initially treated with clobetasol under occlusion and intralesional triamcinolone with minimal improvement. She was subsequently started on prednisone, 15 mg per os daily because of the lung and bone involvement with significant improvement noted in the toe lesions with diminution of both the swelling and violaceous discolouration.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
4/69. Anti-dsDNA antibodies in sarcoidosis.BACKGROUND: sarcoidosis is a chronic multisystem disorder characterized by an exaggerated cellular immune response to antigens with the production of various antibodies including rheumatoid factor and antinuclear antibodies (ANA). The prevalence and significance of antibodies to double-stranded dna (anti-dsDNA) in sarcoid patients is unknown. The occurrence of anti-dsDNA antibodies is known to be a specific marker of systemic lupus erythematosus (SLE). sarcoidosis can occur with SLE. It is unclear if anti-dsDNA antibodies in patients with sarcoidosis signify the eventual development of SLE. OBJECTIVES: To determine the prevalence of anti-dsDNA antibodies in patients with sarcoidosis in a university hospital and their significance in predicting the diagnosis of associated SLE. methods: In a retrospective study, 34 patient files with diagnosed sarcoidosis in a university hospital during a period of 15 years were reviewed for serological markers, including ANA, anti-dsDNA, and immunoglobulin and C3 levels. The occurrence of SLE in these patients also was evaluated. RESULTS: ANA were positive in 10 of 34 of the patients screened. Two patients with sarcoidosis had antibodies to dsDNA. C3 levels in these 34 patients were an average of 87.7 /- 25.3 mg/100 mL, which is within the normal range. IgG immunoglobulin levels were an average of 2,206 /- 999 mg/100 mL, which was above normal limits. The 2 patients who were positive for anti-dsDNA had normal C3 levels and SLE did not develop during a follow-up period of 10 to 15 years. CONCLUSIONS: Anti-dsDNA antibodies may occur in patients with sarcoidosis, but their presence does not predict the subsequent development of SLE.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
5/69. Concurrence of sarcoidosis and aortitis: case report and review of the literature.takayasu arteritis (TA) is a rare manifestation of systemic large vessel vasculitis which affects predominantly the aorta and its main branches, but often remains unrecognised owing to delayed diagnosis and non-characteristic clinical features. sarcoidosis, too, is a systemic inflammatory disease which can affect virtually any organ system. Reports about the coincidence of both diseases have appeared. The case presented here is characterised by a significant time lag between detection of TA and appearance of clinical signs of sarcoidosis. The woman, now 39 years old, had erythema nodosum, circumscript alopecia, and recurrent uveitis, which dated back to 1980 and was attributed to sarcoidosis. At least 12 years later aortic valve insufficiency with progressive cardiac failure developed. histology performed at the time of aortic valve prosthesis in 1997 disclosed a diagnosis of TA, which was confined to the aortic root. Incidentally, sarcoidosis was diagnosed in adjacent lymph nodes. A thorough check up failed to detect further manifestations of TA; thus, possibly, the patients had aortitis similar to, but not identical with, TA.Several related cases previously reported are discussed, suggesting that both diseases may be inherently related as they are characterised by certain non-specific, immunoinflammatory abnormalities. This case report suggests that the prevalence of TA, or related forms of arteritis, may be higher than expected and should be considered, especially in younger patients with non-characteristic cardiovascular symptoms and suspected systemic inflammatory disease. Moreover, the association with sarcoidosis in this and other previously described cases suggests that the two diseases may be related and that TA or TA-like vasculitis may even be a complication of sarcoidosis.- - - - - - - - - - ranking = 92.020801677437keywords = erythema nodosum, nodosum, erythema (Clic here for more details about this article) |
6/69. The association of Sweet's syndrome with sarcoidosis.We report a 43-year-old woman with biopsy proven Sweet's syndrome with massive mediastinal lymphadenopathy. No other clinical signs compatible with sarcoidosis were present. mediastinoscopy was performed to establish a diagnosis. Histological evaluation revealed non-caseating granulomas compatible with sarcoidosis. We review the association of Sweet's syndrome and (haematological) malignancies, and eight other cases of Sweet's syndrome and sarcoidosis. All but one presented with erythema nodosum, making the diagnosis of acute sarcoidosis (Lofgren's syndrome) more likely than malignancy.- - - - - - - - - - ranking = 92.020801677437keywords = erythema nodosum, nodosum, erythema (Clic here for more details about this article) |
7/69. Ulcerative sarcoidosis successfully treated with apligraf.The case of a 73-year-old female patient is reported with a 25-year-long history of widespread cutaneous sarcoidosis without any known extracutaneous manifestations. The skin manifestations started with erythematous and plaque-like lesions that had ulcerated on the legs for the last half-year. A relevant venous insufficiency or other etiology of the ulcers could not be found. histology from lesions of the trunk and from the surroundings of the ulcers revealed the typical noncaseating granulomas. A systemic involvement could not be observed; leukopenia and a slightly elevated angiotensin-converting enzyme level in the serum were found. Topical steroids did not prove successful on the ulcers. Apligraf, a bilayered skin equivalent, was transplanted twice on the ulcers leading to complete closure within 3 months. A therapy with systemic steroids could thus be avoided.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
8/69. Lichenoid sarcoidosis in a 3-year-old girl.We report a case of lichenoid sarcoidosis in a 3-year-old girl. She had numerous discrete skin-colored or erythematous, infiltrated follicular papules on the buttocks and extremities since 2 months of age. Histopathologic examination showed follicular plugging and an upper dermal granulomatous infiltrate of epithelioid cells closely surrounding the follicular ducts. No acid-fast bacilli were seen in the sections examined. Chest radiograph and high-resolution computed tomography (CT) showed no hilar lymphadenopathy or pulmonary parenchymal changes. An angiotensin-converting enzyme level was elevated. The Mantoux reaction was negative and results of ophthalmologic examinations were normal. Treatment was started with triamcinolone 0.2 mg/kg and prednicarbate ointment. Some lesions healed completely and others showed residual pitting.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
9/69. Concurrence of sarcoidosis and systemic lupus erythematosus in three patients.We present three cases of patients with systemic lupus erythematosus and sarcoidosis. Although both of these conditions are thought to involve autoimmune mechanisms they occur together only rarely. Our cases suggest that their concurrence may be more common than previously thought, and raise issues regarding the management of patients with SLE. We discuss the possibility that these two diseases are either causally or mechanistically related.- - - - - - - - - - ranking = 5keywords = erythema (Clic here for more details about this article) |
10/69. A patient with sarcoidosis presenting with acute renal failure: implication for granulomatous interstitial nephritis and hypercalcemia.A woman was admitted for acute renal failure and erythematous lesions. She was diagnosed with sarcoidosis after analysis of biopsy specimens revealed noncaseating epithelioid granulomas, elevated serum angiotensin-converting enzyme levels, and bilateral hilar lymphadenopathy. serum concentrations of ionized calcium and 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] were extremely high. serum intact osteocalcin concentration and urinary deoxypyridinoline excretion were within reference ranges. Treatment with prednisolone induced a prompt improvement with normalization of serum concentrations of ionized calcium and 1,25-(OH)2D3. serum intact osteocalcin concentration was markedly suppressed and urinary deoxypyridinoline excretion increased. It is possible suppressed bone resorption may be associated with overproduction of 1,25-(OH)2D3.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
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