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Medical Mystery

Quillen College of Medicine

Medical Mystery of the Week

   A 45-year-old man with a history of bilateral hilar adenopathy and an elevated angiotensin converting enzyme (ACE) level, presents with persistent asymptomatic lesions on both legs (see photo below).
   What is your diagnosis, what test(s) would you order to confirm your suspicions, and what treatment, if any, do you recommend?  

1

DIAGNOSIS: Sarcoidosis. Sarcoidosis can involve virtually any organ in the body, with cutaneous involvement occurring in about one-third of cases. The classic cutaneous lesions include erythema nodosum (typically in association with hilar adenopathy and uveitis [Löfgren's syndrome]), maculopapular lesions, hyper- and hypopigmentation, subcutaneous nodules, and in chronic sarcoidosis, lupus pernio (involvement of the bridge of the nose, the suborbital areas, and the cheeks in a manner that resembles the butterfly rash of lupus erythematosus). In the presented case, granulomatous nodules have coelesced forming the lesions seen in the photograph. In cutaneous forms of sarcoidosis, the diagnosis is readily established by biopsy. Hydroxychloroquine and minocycline are the drugs of choice for cutaneous disease.

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