Rituximab‐induced mucosal pyogenic granuloma

Abstract

occasional foreign body giant cell and sclerosis (Figure 2b). Fite-Faraco for atypical mycobacteria and PAS staining for fungus were negative. Thus, clinically mimicking linear morphea and histopathology eliciting sarcoidosis made our case unique.Hence, a definitive diagnosis of morpheaform sarcoidosis was made based on clinical, dermoscopy, and histopathological findings. The patient improved with oral corticosteroids, weekly methotrexate injections, and topical tacrolimus. Sarcoidosis is a multisystem disease characterized by granulomatous inflammation of unknown etiology commonly affecting lungs and skin. 1 A review of literature showed eight cases of morpheaform sarcoidosis to date. [1][2][3][4][5][6] Biopsy findings were consistent with findings of cutaneous sarcoidosis. ACE levels were elevated in four patients while ANA was positive in two patients. There were five patients with pulmonary involvement with abnormal chest x-ray findings and restrictive patterns in pulmonary function tests. Treatment given was oral and topical corticosteroid mainly. [1][2][3][4][5][6] In our present case, clinical lesions were consistent with linear morphea and were correlated with dermal sclerosis on biopsy. Dermal sclerosis could be because of the release of number of cytokines by activated T-cells and macrophages during the process of formation of granuloma. 1 Another feature in biopsy was the presence of non-caseating granuloma consistent with the diagnosis of sarcoidosis, hence leading us to the diagnosis of morpheaform sarcoidosis. In our present case, we have evaluated dermoscopically, which has not been mentioned in earlier reports.Herein, we are reporting a case of morpheaform sarcoidosis mimicking linear morphea over the right upper and lower limb in a 16-year-old-young girl. Our case report sensitizes the dermatologist fraternity regarding consideration of sarcoidosis in the differential diagnosis of indurated skin lesions and evaluation accordingly to prevent complications of untreated sarcoidosis.