Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India.
Department of Pathology, Delhi Dermpath Laboratory, Delhi Dermatology Group, New Delhi, India.
Dermatol Ther. 2019 Jul;32(4):e12968. doi: 10.1111/dth.12968. Epub 2019 May 30.
Cutaneous manifestations in sarcoidosis are seen in 25-35% of patients with systemic disease and may be the sole manifestation in few patients. It is known that isolated cutaneous sarcoidosis is a great mimicker and can be easily misdiagnosed as other granulomatous conditions especially lupus vulgaris in regions with high burden of tuberculosis (TB). Here we present a case with cutaneous sarcoidosis who was initially misdiagnosed and treated as bifocal lupus vulgaris with antitubercular therapy (ATT) for 6 months. This nonresponsiveness to therapy prompted us to investigate the patient further for other differentials, failing which a diagnosis of cutaneous sarcoidosis was made and the patient was treated with oral steroids and methotrexate with complete clearance of lesions after 14 weeks of therapy. Our case reemphasizes the value of therapeutic trial of ATT in diagnosis of cutaneous TB and highlights the remarkable clinical mimic of sarcoidosis with lupus vulgaris.
皮肤结节病表现见于 25-35%的系统性疾病患者，少数患者可能仅有皮肤表现。已知孤立性皮肤结节病是一种很好的模仿者，在结核病（TB）负担高的地区，很容易误诊为其他肉芽肿性疾病，特别是寻常狼疮。在这里，我们介绍了一个病例，该患者最初被误诊为双灶寻常狼疮，并接受抗结核治疗（ATT）治疗 6 个月。由于对治疗无反应，我们进一步检查了其他鉴别诊断，在未能明确诊断的情况下，诊断为皮肤结节病，并给予口服类固醇和甲氨蝶呤治疗，治疗 14 周后皮损完全消退。我们的病例再次强调了 ATT 治疗试验在诊断皮肤结核中的价值，并突出了结节病与寻常狼疮的显著临床相似性。
