Cutaneous sarcoidosis: clinical profile of 23 Indian patients.

BACKGROUND: Sarcoidosis is a multisystem disease of undetermined etiology. Indian studies on cutaneous sarcoidosis are not many and mainly comprise case reports. AIMS: This retrospective study was carried out to assess the clinical profile of sarcoidosis patients presenting with cutaneous lesions. METHODS: All histopathologically proven cases of cutaneous sarcoidosis seen consecutively between 1999 and 2004 were studied. Their age, sex, presenting features, evolution of disease and laboratory parameters were analyzed. RESULTS: A total of 23 patients (F:M 15:8) between 31 to 78 years (mean 44.3 years) of age had the mean duration of skin lesions of 1.4 years. Six patients had one to four lesions; two patients each had scar sarcoidosis and angiolupoid and one patient each had recurrent erythema nodosum, leg lymphedema and subcutaneous sarcoidosis. Others showed combination of papules, nodules, plaques and psoriasiform lesions. Peripheral lymph nodes were involved in two patients. Among 10 patients of pulmonary involvement, three had become symptomatic four months to four years after the cutaneous lesions. Routine laboratory investigations including serum calcium estimation were normal in all cases. Serum angiotensin-converting enzyme levels were raised in 3 out of 6 patients. Asymptomatic lytic lesions of digital bones were detected in hand X-ray of one patient. CONCLUSION: Skin lesions of sarcoidosis are like the tip of an iceberg indicating more changes in other organs. The symptomatology and abnormal laboratory results do not necessarily correlate with the severity of cutaneous involvement in general.

Hansen´s Disease in a patient with a history of sarcoidosis

We report a rare case of concomitant Hansen's disease (HD) and sarcoidosis. Reticulin staining may be a helpful diagnostic tool in establishing the diagnosis of sarcoidosis in skin lesions. The diagnosis of HD can be established despite negative polymerase chain reaction results for the detection of Mycobacterium leprae DNA. Finally, a well-established diagnosis of sarcoidosis does not preclude the development of another granulomatous disorder. Hence, when new lesions developed in a patient with sarcoidosis despite appropriate therapy, other concurrent diagnoses should be pursued.

Doenças granulomatosas da laringe / Granulomatous diseases of the larynx

Realizamos uma revisäo sobre as principais doenças granulomatosas que podem acometer a laringe, devido à grande ocorrência dessas afecçöes no Brasil e em outros países de clima tropical e subtropical. Ressaltamos os aspectos histopatológicos para o seu diagnóstico, assim como o seu tratamento.

Tuberculose não caseosa (Sarcoide de Boeck), tuberculose caseosa e lepra lepromatosa: caso de necropsia / Non-caseous tuberculosis (Sarcoid of Boeck), caseous tuberculosis and lepromatous leprosy: case necropsy

O autor apresentou um caso no qual a necropsia mostrou granulomas de tuberculoide produtiva não caseosa (sarcoide de Boeck), de tuberculose caseosa (classica) e de lepra lepromatosa. Fôram encontrados bacilos acido-resistentes em nodulos de tuberculose não caseosa. Os granulomas de tuberculose não caseosa estavam transformando-se em granulomas de tuberculose caseosa.

Lepra tuberculoide com sindrome de Besnier Boeck Schaumann / Tuberculoid leprosy with syndrome of Besnier Boeck Schaumann

- Los autores presentan un caso de lepra tuberculoide con lesiones cutáneas y viscerales semejantes a las descritas en el Sindrome de Besnier-Boeck-Schaumann (B.B.S.). - Dermatológicamente presenta las manchas eritematosas, los pequeñosy grandes nódulos descritos por Boeck en su Sarcoide y placas infiltradas cianóticas, semejantes a las del lupus pernio. La sensibilidad a nivel de la mayoría de esas lesiones está alterada y la investigación del Mycobacterium leprae en las mismas resultó positiva. - El estudio histológico evidencia la típica estructura sarcoídica con infiltraciones nodulares en dermis y hipodermis a gran predominio epiteliode con escasos linfocitos y ausencia de células gigantes;pero lo característico en este caso es la alteración de los nervios reflejada por la invasión del infiltrado en los mismos y por la neuritis intersticial, hecho al que asignan valor diferencial entre el sarcoide leproso y no leproso. - Como lesiones extracutáneas y otros caracteres que justifican calificarlo como un caso de sindrome de B.B.S., describen: la adenopatía, las lesiones pulmonares, tumefacciones articulares, la monositosis y la anergia tubeculínica. - La adenopatia en ese caso es inguinal y axilar doble, pero los ganglios mayores, (algunos del tamaño de una avallana grande) se encuentran en la axila. El estudio histológico de uno de esos ganglios revela abundantes y tipicos nidos epiteliodes. La búsqueda del Mycobacterium leprae dió resultados positivos y la inoculación al cabayo de un triturado de ese ganglio fué completamente negativa. - La radiografia del pulmón revela imágenes idénticas a las que se observan en el Sarcoide de Boeck, como ser: Adenopatia hiliar y nódulos parenquimatosos, bien delimitados a punto de partida hiliar (Prof. Bonila). - No se encontraron radiológicamente las lesiones óseas descritas por Jungling (Osteitis cistoides y en parrilla, pero en cambio se constataron clinicamente marcadas tumefacciones periarticulares de muñecas, rodilla y t