Sarcoidosis in a Preschooler with Only Skin and Joint Involvement

Abstract

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. It is relatively rare in children less than 15 years of age and especially in those less than 5-6 years of age. Sarcoidosis characteristically involves the skin, eyes, and synovial tissues in patients less than 5-6 years of age. We report a 3-year-old boy with sarcoidosis who had cutaneous findings with joint symptoms. Dermatologic examination revealed lichenoid, erythematous, 2-3 mm papules, some of them grouped, all over his extremities and trunk. There were symmetric swellings on his ankles and wrists without erythema or pain which did not interfere with function. However, until now, no eye involvement had been detected in the patient.

Icthyosiform Eruption and Swollen Articulations in a Girl

“…11 Joint involvement is common in children and is described as boggy, nondeforming, painless articular changes. 2,12 In our case, the skin changes appeared at 5 months of age, preceding the articular involvement as is commonly reported.…”

“…In the second group, the presentation is between 8 and 15 years of age, and this group resembles the adult group in presentation, with systemic involvement affecting the eyes, lungs, and lymph nodes. 2 The cause of this condition is unknown; an antigenic stimulus and a genetic predisposition are required to produce granulomatous inflammation. 3 Sarcoidosis is characterized by multiple granulomas, which are defined as compact collections of macrophages and epitheloid cells encircled by lymphocytes.…”

The granulomatous reaction pattern

“…34 An erythema nodosum-like eruption with the histological changes of sarcoidosis has also been described. 40 Children presenting before the age of 4 years, usually have the triad of rash, uveitis, and arthritis, 41,42 without apparent pulmonary involvement. [36][37][38][39] There are reports of its occurrence in monozygotic twins.…”

Widespread Granulomatous Dermatitis of Infancy

“…3 Massive swelling of the tendon sheaths and synovia accompanied by a relatively normal range of motion, minimal pain, and a lack of x-ray film evidence of erosive joint changes until later in the disease process favor a diagnosis of EOS/BS instead of juvenile rheumatoid arthritis. [1][2][3]59 Anterior or panuveitis is the most common ocular manifestation of EOS/BS and may present with eye pain, photophobia, and blurred vision. 14,28,38 Granulomatous inflammation can also involve the conjunctiva, lacrimal glands, retina, and optic nerve, and ocular complications include cataracts and glaucoma.…”

“…54,59 In patients with uveitis, progressive joint disease, visceral involvement, or skin lesions that are extensive and/or symptomatic, therapy is often initiated with systemic corticosteroids. Because the granulomatous inflammation is prone to relapse on medication withdrawal, steroid-sparing agents such as tumor necrosis factor inhibitors (eg, infliximab), methotrexate, cyclosporine, and other immunosuppressive medications may be required.…”