Atypical manifestations of sarcoidosis in a Hispanic male - PubMed (original) (raw)
Case Reports
Atypical manifestations of sarcoidosis in a Hispanic male
Bao Ho et al. J Community Hosp Intern Med Perspect. 2019.
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology that can present with nonspecific features, often resulting in delayed diagnosis. The diagnosis requires the demonstration of non-caseating granulomas on biopsy. While the prevalence of sarcoidosis in the USA is rare, the disease is rarer yet in Hispanics. It is for this reason that we report herein the case of a Hispanic gentleman with a unique clinical manifestations of sarcoidosis. With what began as a two-month history of joint pain and skin rash, this 55-year-old man was hospitalized with multiple joint pain, weight loss, fatigue and a pruritic rash with leonine facies in the setting of anemia, leukopenia, hypercalcemia, elevated serum creatinine, and urine Bence-Jones proteinuria. CT imaging of the chest was nonspecific, but skin biopsy revealed non-caseating granulomatous disease. After completing an infectious and malignancy evaluation, the patient was diagnosed with sarcoidosis, which was treated successfully with low-dose steroid therapy.
Keywords: Sarcoidosis; hypercalcemia; leonine facies; nephrocalcinosis; non-caseating granulomas.
Figures
Figure 1.
Left arm, antecubital area, discrete, multiple well-demarcated, edematous, erythematous papules and plaques.
Figure 2.
Face, frontal view. Leonine facies: Diffuse skin infiltration, multiple nodular lesions.
Figure 3.
Histopathology, skin biopsy, taken from left arm. H&E staining 200 x magnification showing non-caseating granulomatous dermatitis.
Figure 4.
Trends in WBC, serum creatinine, and albumin-corrected calcium over 10 hospital days. There is sustained improvement in WBC, creatinine, and calcium levels after administration of oral prednisone, as noted on hospital day 6.
References
- Judson MA, Thompson BW, Rabin DL, et al. The diagnostic pathway to sarcoidosis. Chest. 2003February;123(2):406–412. -PubMed
- Baughman RP, Field S, Costabel U, et al. Sarcoidosis in America. Analysis based on health care use. Ann Am Thorac Soc. 2016August;13(8):1244–1252. -PubMed
- Fernandez-Faith E, McDonnell J.. Cutaneous sarcoidosis: differential diagnosis. Clin Dermatol. 2007May-Jun;25(3):276–287. -PubMed
- Marchell RM, Thiers B, Judson MA.. Chapter 152. Sarcoidosis In: Goldsmith LA, Katz SI, Gilchrest BA, et al, editors. Fitzpatrick‘s dermatology in general medicine. New York, NY: McGraw-Hill; 2012. p. 8e.
- Kendrick CG, Brown RA, Reina R, et al. Cutaneous sarcoidosis presenting as leonine facies. Cutis. 2004January;73(1):57–62. -PubMed