Necrobiosis Lipoidica Mimicking Cutaneous Sarcoidosis Finally Treated With an Intralesional Injection of Corticosteroid: A Case Report

January 2020 | Volume 19 | Issue 1 | Case Reports | 92 | Copyright © January 2020

Mohamad Goldust MD,a,b,c Ghasem Rahmatpour Rokni MD,d Jeffrey M. Weinberg MD,e Leon Kircik MD,e Martine Bagot MD,f Ali Mirabid

aUniversity of Rome G. Marconi, Rome, Italy; Department of Dermatology, bUniversity Medical Center Mainz, Mainz, Germany; Department of cUniversity Hospital Basel, Basel, Switzerland dMazandaran University of Medical Sciences, Sari, Iran eIcahn School of Medicine at Mount Sinai, New York, NY fDepartment of Dermatology, Hopital Saint-Louis, Paris, France

Abstract
BACKGROUND: Necrobiosis lipoidica (NL) and sarcoidosis are granulomatous disorders with an unknown pathogenesis. They may coexist in the same patient, which suggests a possible overlap between these diseases among shared granulomatous inflammatory pathways. Case Presentation: This study presents the case of a non-diabetic 52-year-old woman who presented with red-yellowish border plaques on the face and upper extremities previously diagnosed as sarcoidosis. After 13 years of inappropriate treatment, histopathological findings consistent with the clinical and para-clinical examination suggested the diagnosis of NL. After treatment with an intralesional injection of steroids, significant improvement was observed, and no recurrent lesions were found.

CONCLUSION: Necrobiosis lipoidica may mimic cutaneous sarcoidosis. Prompt recognition and treatment of NL can be helpful for managing the disease.

J Drugs Dermatol. 2020;19(1): doi:10.36849/JDD.2020.4675

INTRODUCTION

Necrobiosis lipoidica (NL) and cutaneous sarcoidosis are rare granulomatous diseases. Sarcoidosis is a chronic multisystem inflammatory disease, which can involve any part of the body. The cutaneous form of sarcoidosis was observed in 25% to 30% of NL patients and has a varying clinical morphology.1,2 In the histopathology, cutaneous sarcoidosis is characterized as clusters of epithelioid histiocytes without significant necrosis or surrounding lymphocytic infiltrates. NL can develop in any patient, but approximately 60% occurs in type 1 diabetic patients.3-5

Herein we report the case of a 52-year-old non-diabetic woman who was misdiagnosed with cutaneous sarcoidosis for 13 years. Clinically she presented with painless red-yellowish plaques with an erythematous border on the upper extremities. She was treated with an intralesional injection of steroids, and improvement was observed within 3 weeks.

CASE PRESENTATION

A 52-year-old woman presented to a dermatologist with annular painless red-yellowish plaques with an erythematous border on the face and upper extremities. The patient described a 13-year history of cutaneous sarcoidosis, which was treated with prednisolone 10 mg to 15 mg/daily for 5 years and calcium 400 mg/ daily. When symptoms continued after 5 years, she looked for a second opinion. A clinical eye examination revealed intact disc, macula, and vessels. Additional laboratory tests were negative -- including blood biochemistry tests, complete blood count, erythrocyte sedimentation rate, blood urea nitrogen, creatinine, alkaline phosphatase, calcium, C-reactive protein, and purified protein derivative tests. Antinuclear antibody, anti-DNA, and angiotensin-converting-enzyme tests were also negative. Urinalysis was normal. Chest X-ray and spiral multidetector computed tomography showed no fibrosis or interstitial lesions; but a few small nodules were present at the peripheral middle zone on both lungs. In addition, high-resolution computed tomography showed no pleural effusion, lymph node enlargement, sor mediastinal masses; however, fibrotic changes in the parenchymal view of the inferior lung area were observed, potentially caused by an infectious lesion.

The following diagnoses were proposed: necrobiosis lipoidica, lupus vulgaris, sarcoidosis, and granuloma annulare. A biopsy of the lesions was taken. A histopathological examination of the