Sarcoidosis- A Rare Disease Diagnosis by Cutaneous Manifestation, Clinical and Histopathological Correlation

Abstract

BACKGROUND Sarcoidosis is a multisystem disease the aetiology of which is still undetermined even after extensive search. Caesar Boeck, the pioneering Norwegian dermatologist used the term "multiple benign sarcoid of the skin" for sarcoidosis. Many articles have been published and research is still going on. We wanted to evaluate the diagnosis of sarcoidosis with cutaneous lesions of various morphology along with the clinical profile and relevant investigations including histopathological examination of those patients who attended outpatient department at School of Tropical Medicine for last 5 yrs. METHODS We conducted combined prospective and retrospective observational study of skin biopsy cases of 39 patients having clinically suspected cutaneous lesions from January 2014 to December 2018 (sample size taken as per convenience). This study was conducted at the Department of Pathology in correlation with the Department of Dermatology in School of Tropical Medicine, Kolkata. RESULTS A total of 39 clinically suspected cases of sarcoidosis in 36-40 years age group were included in the study. 11 showed non-caseating granulomas and diagnosis of sarcoidosis had been considered after clinical correlation along with other relevant investigations. The patients presented with brown red or purple popular lesions over skin of face, chest wall, back, upper extremities for a period of 6 months to 1 year. 4 cases presented with dry cough, occasional fever, weight loss and arthralgia and 2 cases had dyspnoea and palpitation. Poly-arthralgia involving knee, ankle, elbow with skin lesions was present in 2 patients. One patient had recurrent fever, arthralgia, erythema nodosum over ankle, feet and shin bone. Two patients had only skin lesions without any systemic illness. CONCLUSIONS Diagnosis of sarcoidosis is tricky and often confused with other diseases. Its diagnosis is by method of exclusion. In most cases, definite diagnosis requires a biopsy of skin, lymph node or lung.