Chronic verrucous plaques on bilateral lower extremities: Ca
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A 40-year-old male with past medical history of diabetes mellitus and hydrocephalus requiring ventricular-peritoneal shunt placement was admitted to the Neurology Intensive Care Unit for workup of altered mental status.

Dermatology was consulted for evaluation of chronic fungating lower extremity lesions. Family history was significant for pulmonary sarcoidosis in his mother and unknown type of sarcoidosis in his sister. Physical examination revealed well demarcated, hyperkeratotic, verrucous plaques on his bilateral lower legs without drainage or tenderness. Biopsies were obtained for hematoxylin and eosin staining and bacterial, fungal, and acid-fast bacilli deep tissue cultures, which were negative.

The diagnosis turned up to Cutaneous sarcoidosis that often presents a diagnostic challenge due its ability to mimic other dermatologic conditions, and verrucous sarcoidosis is an extremely rare subtype. It generally presents as well demarcated exophytic and hyperkeratotic plaques, as seen in this patient, or discrete papillomatous papules. For rapidly progressing or severely disfiguring verrucous sarcoidosis such as seen in this patient, systemic glucocorticoid therapy is the first line treatment option. Patients with verrucous sarcoidosis typically have significant pulmonary sarcoidosis as well. This patient’s lack of pulmonary involvement makes this a unique case.

Source: https://www.jaadcasereports.org/article/S2352-5126(20)30798-0/fulltext?rss=yes
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