Sarcoidosis presenting as papulonecrotic tuberculid-like lesions: report of a case
Chalermdamrichai, P.; Puavilai, S.; Jerasutus, S.; Boonsarngsuk, V.; Kiattboonsri, S.; Suwatanapongched, T.
Journal of the Medical Association of Thailand 87(7): 839-844
2004
ISSN/ISBN: 0125-2208 PMID: 15521243 Document Number: 2501
A 50-year-old Thai woman presented with papulonecrotic tuberculid-like eruptions on her back and inframammary area with fever, nonproductive cough and weight loss. Chest radiograph showed diffuse bilateral reticulonodular opacities in both lungs with bilateral hilar lymph node enlargement. High resolution computed tomography (HRCT) of the lungs showed peribronchovascular interstitial thickening with multiple lymph nodes enlargement. Sputum for AFB was negative. Monotest (PPD) was negative. Skin biopsy revealed multiple naked granuloma compatible with sarcoidosis. She was treated with isoniazid, 300mg/d, rifamipicin, 600 mg/d, ethambutal, 800, mg/d and pyrazinamide, 1000 mg/d for 2 months without improvement of skin and lung lesions. Prednisolone 45 mg/d was then administered adjunctive with isoniazid and rifampicin. After two weeks of treatment with prednisolone, the cutaneous and pulmonary lesions markedly improved. Prednisolone was tapered in 6 months. Skin lesions, fever, dry cough disappeared and chest radiograph, HRCT of the chest were markedly improved.
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