Answer to the last #DiagnosticDilemma
A Man With Infiltrated Plaques on the Pretibial Area

Final Dx: CUTANEOUS SARCOIDOSIS

CLINICAL PEARLS
Cutaneous sarcoidosis has myriad clinical presentations and is a “great imitator” of many other cutaneous diseases. Hence, the clinical index of suspicion has to be high. It is characterized by noncaseating granulomas in 1 or more organ systems. Skin lesions are present in at least 20% of sarcoidosis cases and are the initial disease manifestation in nearly one-third.

Diagnosis of cutaneous sarcoidosis can be challenging, especially when the cutaneous presentation is atypical. All cases should undergo histopathological analysis and other laboratory and radiological tests. Biopsy shows the classic noncaseating granulomatous inflammation with sparse lymphocytes and plasma cells (so-called naked granulomas).

FINAL OUTCOME
This patient had an uncommon presentation of plaque sarcoid with atrophy that mimicked other common skin diseases involving the lower leg such as necrobiosis lipoidica and pretibial myxedema. The diagnosis was confirmed histopathologically. The lesions responded well to oral corticosteroids, which were tapered and stopped after 6 months with no evidence of recurrence.

Source: https://jamanetwork.com/journals/jamadermatology/article-abstract/2678836
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