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Images of Memorable Cases: Case 140

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Case_140-pres1-1.jpg

This 47-year-old woman presented with a swollen and minimally tender right thumb. She felt fine otherwise and had no additional complaints.

140. Cutaneous sarcoidosis with sarcoidal dactylitis

The papules on and around this patient’s nares, and those on her upper eyelids near the inner canthus, strongly suggested sarcoidosis. A radiograph of her affected right thumb demonstrated a lytic lesion in the tip of the distal phalanx. Biopsies of that lesion and a nasal papule showed noncaseating granulomas containing multinucleated giant cells typical of sarcoidosis.

This case illustrates an important clinical point: When bone lesions occur in patients with sarcoidosis, chronic sarcoidal skin changes are almost always present as well.

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