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.
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
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
