Sarcoid lesions

Noguchi K, Enjoji M, Nakamuta M, Sugimoto R, Kotoh K, Nawata H. Various sarcoid lesions in a patient induced by interferon therapy for chronic hepatitis C. J Clin Gastroenterol 2002 35(3) 282-4. 

Specific sarcoid lesions most often are found on the head and neck but may occur symmetrically or asymmetrically on any part of the skin and mucosa (31). Almost all morphologies have been reported including macules, papules, patches, plaques, and nodules (31). 

Another distinctive specific sarcoidosis skin lesion is lupus pernio, relatively symmetric, violaceous, indurated plaque-like and nodular sarcoidal lesions occurring on the nose, ear lobes, cheeks, and digits (Figs. 6 and 7). Lupus pernio... 

Granulomatous dermatitis with disseminated pruritic papules and histological features resembling those of sarcoid granulomas has been described in a 57-year-old man who received interferon beta-lb (58). The first lesions were observed after 2 months of treatment, persisted for 2 years, and slowly improved after interferon beta withdrawal and treatment with hydroxychloroquine PUVA. 

Oliver SJ, Kikuchi T, Krueger JG, et al. Thalidomide induces granuloma differentiation in sarcoid skin lesions associated with disease improvement. Clin Immunol 2002 102 225-236. 

Figure 9 HRCT scan demonstrates dense alveolar consolidation, multiple nodules, sarcoid galaxies, and traction bronchiectasis. Note the cavitary lesion with a mycetoma. Abbreviation-. HRCT, high-resolution thin-section CT.

Uveitis is the most common ocular manifestation of sarcoidosis in most series (4,5). Anterior uveitis occurs in 20% to 70% of patients with ocular sarcoidosis (4—6) and typically presents as an iritis or iridocyclitis (1,7). Symptoms include blurred vision, red eyes, painful eyes, and photophobia. However in one-third of patients, the patient may present without ocular symptoms. Therefore, all sarcoidosis patients require a slit-lamp and fundoscopic examination regardless of the presence of ocular symptoms. The slit-lamp examination may reveal mutton-fat keratic precipitates (Fig. 1), which are aggregates of inflammatory cells in the comeal epithelium (1,7). Other lesions of anterior sarcoid uveitis that may be seen with a slit lamp include Busacca nodules on the iris (Fig. 2) and Koeppe nodules on the papillary margin (8). Both these nodules are almost exclusively found when anterior sarcoid uveitis is a chronic condition (8). Chronic anterior sarcoid uveitis may cause cataracts and glaucoma. Since corticosteroid use can also lead to cataract formation and... 

Cutaneous sarcoidosis lesions are divided into two categories specific and nonspecific. Specific lesions reveal granulomatous inflammation on biopsy. Nonspecific skin findings are reactive inflammatory lesions that do not exhibit sarcoidal granulomas. 

AUopurinol (50), isotretinion (51), fumaric acid esters (52), mycophenolate mofetil (53), and Tranilast (54) have been reported to be effective for sarcoidal skin disease. Resolution of sarcoidal skin lesions has occurred after radiation therapy (55), ultraviolet A1 therapy (56), phototherapy, and photodynamic therapy (57). 

Sarcoid bone involvement occurs in 1% to 13% of patients (213). It is most common in patients between the ages of 30 and 50 and in African Americans (213). Bone lesions are most common in the bones of the hands and feet however, the nasal bones, skull, and vertebrae may be affected (213). The lesions are often asymptomatic and routinely found on radiographic or MR studies. Radiologic findings usually show cystic or punched-out lesions (221). Sarcoidosis arthritis is usually treated with nonsteroidal anti-inflammatory agents (215), which are especially useful for acute sarcoid arthritis. Chronic destructive synovitis may require systemic corticosteroids or intra-articular injections (213). The addition of azathioprine or methotrexate may improve results and be corticosteroid sparing (213). 

Sarcoidosis of the breast may occur presenting as a lesion seen on mammography or a palpable breast mass (231,232). It is important that a breast mass detected in a sarcoidosis patient is not assumed to be related to the disease, as the patient may have concomitant breast carcinoma. This is particularly pertinent as patients with breast carcinoma may have related sarcoid-like reactions in extramammary sites (233). 

Nadel EM, Ackerman LV. Lesion resembling Boeck s sarcoid in lymph nodes draining an area containing a malignant neoplasm. Am J Clin Pathol 1950 20 952-957. 

Skin Sarcoid granulomas developed at the site of previous facial cosmetic filler insertion in a 56-year-old woman receiving RBV and PEG-PEG-IFNa alpha for 3 months [99 ]. The lesions regressed after 6 months following withdrawal of both agents. 

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