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Author Credentials

Kathryn Taylor, BS - MS3 Clayton Curry, BS - MS4 Evan Stalnaker, MD - PGY1 Hannah Leport, MD - PGY2 Morgan Stickler, MD - Assistant Professor Tammy Bannister, MD - Professor

Author ORCID Identifier

Tammy Bannister - ORCID ID -

0000-0003-4971-3557

Keywords

Subcutaneous Nodules, Sarcoidosis, Dermatologic Presentation

Disciplines

Medicine and Health Sciences

Abstract

Sarcoidosis is a multisystem granulomatous disease primarily characterized by pulmonary manifestations. Extrapulmonary involvement in sarcoidosis is well documented and common, but isolated extrapulmonary involvement is rare at around 10% of cases at the time of diagnosis. Cutaneous presentations vary significantly, with erythema nodosum being the most common. Since extrapulmonary symptoms most likely suggest systemic involvement, any way to identify sarcoidosis early is paramount. We present a case of a 63-year-old Caucasian female with multiple palpable 0.5-3cm nodules under the skin of the bilateral forearms, left hand, and lower extremities. A biopsy of a lesion revealed numerous sarcoidal phenotype granulomas without necrosis surrounded by a mild lymphocytic infiltrate. Imaging confirmed calcified mediastinal, hilar, and sub-carinal lymph nodes, as well as revealed scattered calcified and non-calcified granulomas in the upper lung fields. Treatment is not always required, and this patient’s subcutaneous nodules resolved with a single course of steroids. Therefore, it is vital for primary care providers to maintain a high index of suspicion for sarcoidosis with various dermatological findings, as it may be the presenting symptom for sarcoidosis and allow early recognition, monitoring, and intervention.

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