No abstract

Dear Editor, Sarcoidosis is a multisystem inflammatory disease of unknown etiology that manifests as noncaseating granulomas. Skin involvement is frequent, occurring in 25-35% of cases. 1 We report a case of sarcoidosis manifested as livedo on the lower limbs, which is an atypical and rare presentation. A 52-year-old woman presented with fatigue, intermittent low fever, and erythematous patches on both legs, followed by a local burning sensation for over a month. She reported a prior history of arthralgia of the hands and knees for 4 years. Skin examination showed erythematous-violaceous livedoid macules symmetrically distributed on the anterior and medial surface of the thighs and knees (Figure 1). Histopathological examination of the livedo area showed uniform sarcoid granulomas composed of histiocytes with large and eosinophilic cytoplasm, vesicular oval nucleus, and prominent nucleolus, in association with Langhans giant cells. The periphery of the granulomas showed scarce lymphocyte infiltrate (naked granuloma). The connective tissue was normal with absent vasculitis (Figure 2). Due to clinical and histopathological findings, the diagnosis of cutaneous sarcoidosis was established. Laboratory results revealed microcytic and hypochromic anemia with hemoglobin level of 10.5 g/dL, erythrocyte sedimentation rate of 20mm/h, and angiotensin-converting enzyme level of 107 U/L (20-70 U/L). Results for p-ANCA and cAN -CA were both negative. Chest computed tomography revealed diffuse bilateral distribution of multiple centrilobular nodules and bronchial wall thickness (Figure 3