The correct diagnosis is sarcoidosis, a granulomatous multi-system disease of uncertain etiology.
Approximately one-third of patients with sarcoidosis complain of mild fever (which can last for months), fatigue, and weight loss. Incidence is five to 15 times higher in blacks than in whites; black women are infected approximately twice as often as black men. Constitutional symptoms occur more frequently in Asians and blacks.
Respiratory symptoms include a dry cough, dyspnea, chest pain, and tightness of the chest. Uveitis can present with photophobia, redness of the eye, and cloudy vision. Lymphadenopathy has a predilection for the axillary, cervical, epitrochlear, and inguinal locations. Splenomegaly is sometimes detectable. Salivary and lacrimal glands can be enlarged, and there may be involvement of the heart, gastrointestinal tract, and upper respiratory tract.
Like syphilis, sarcoidosis is a great imitator of other dermatoses. Violaceous, firm papules can appear at the distal nose (known as lupus pernio), and similar lesions can affect the ears, lips, and face. Firm, smaller papules can be scattered on the cheeks. Larger plaques of violaceous color can appear on the face, extremities, buttocks, and back. Pre-existing scars are common sites for cutaneous lesions to form. Erythema nodosum involving the lower extremities is also seen.
Check for enlarged lacrimal glands by everting the upper eyelid. Lesions can have significant atrophy in addition to infiltration. Serum ACE level is elevated in approximately 60 f patients, but there is a high false–positive incidence; therefore, the diagnostic value of this test is limited.
Chest radiography will reveal bilateral hilar adenopathy with or without pulmonary infiltrates. A pulmonary function test will show decreased vital capacity, residual volume, and total lung capacity. Lesional skin biopsy reveals well-defined oval or round granulomas, with limited numbers of lymphocytes at the periphery of the lesion.
Case presented by Logical Images, Inc.
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