Hunt S J, O'toole E, Philips W, Hardman C, Wakelin S H, Walters S
Department of Dermatology and Paediatrics, St. Mary's Hospital, London, UK.
Clin Exp Dermatol. 2002 Sep;27(6):448-50. doi: 10.1046/j.1365-2230.2002.01047.x.
Cutaneous sarcoidosis is rare in children. We report a case of a 5-year-old Bangladeshi girl who presented with fever, a papular eruption on the lower limbs and trunk, malaise, anorexia and weight loss. There was multisystem involvement with marked hepatosplenomegaly, generalized lymphadenopathy, parotid fullness and chronic uveitis. Pulmonary infiltrates were seen on the chest X-ray. Histology of a skin biopsy showed naked noncaseating granulomata and PCR for Mycobacterium tuberculosis was negative. A clinical diagnosis of sarcoidosis was made. The patient was treated with oral prednisolone (2 mg/kg per day). An excellent clinical response with resolution of the rash and improvement of extracutaneous signs was noted within 3 months and she remains well on low-dose prednisolone on alternate days. We discuss the presentation and management of sarcoidosis in children, and highlight the potential difficulty in differentiating this from disseminated tuberculosis.
儿童皮肤结节病较为罕见。我们报告一例5岁孟加拉裔女孩，她出现发热、下肢及躯干丘疹样皮疹、不适、厌食和体重减轻。存在多系统受累，伴有明显肝脾肿大、全身淋巴结肿大、腮腺饱满及慢性葡萄膜炎。胸部X线检查可见肺部浸润。皮肤活检组织学显示裸结节状非干酪样肉芽肿，结核分枝杆菌聚合酶链反应（PCR）为阴性。做出结节病的临床诊断。患者接受口服泼尼松龙治疗（每日2毫克/千克）。3个月内观察到皮疹消退及皮肤外体征改善，临床反应良好，她继续隔天服用低剂量泼尼松龙，情况良好。我们讨论了儿童结节病的临床表现及治疗，并强调了将其与播散性结核病相鉴别的潜在困难。
