Sarcoidosis Presenting as Papulonecrotic Tuberculid-like Lesions: Report of a Case
Phanorn Chalermdamrichai MD*, Siripen Puavilai MD*, Suthep Jerasutus MD*, Viboon Boonsarngsuk MD*, Sumalee Kiattboonsri MD*, Thitiporn Suwatanapongched MD**
Affiliation : * Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, ** Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
A 50-year-old Thai woman presented with papulonecrotic tuberculid-like eruptions on her back and inframammary area with fever, nonproductive cough and weight loss. Chest radiograph showed diffuse bilateral reticulonodular opacities in both lungs with bilateral hilar lymph node enlargement. High resolu- tion computed tomography (HRCT) of the lungs showed peribronchovascular interstitial thickening with multiple lymph nodes enlargement. Sputum for AFB was negative. Monotest (PPD) was negative. Skin biopsy revealed multiple naked granuloma compatible with sarcoidosis. She was treated with isoniazid, 300mg/d, rifamipicin, 600 mg/d, ethambutal, 800, mg/d and pyrazinamide, 1000 mg/d for 2 months without improvement of skin and lung lesions. Prednisolone 45 mg/d was then administered adjunctive with iso- niazid and rifampicin. After two weeks of treatment with prednisolone, the cutaneous and pulmonary lesions markedly improved. Prednisolone was tapered in 6 months. Skin lesions, fever, dry cough disappeared and chest radiograph, HRCT of the chest were markedly improved.
Keywords : Systemic sarcoidosis, Papulonecrotic tuberculid, Cutaneous manifestation
