title: Sarcoidosis presenting as papulonecrotic tuberculid-like lesions: report of a case.
abstract: 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, 300 mg/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.
authors.affiliation: Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Phanorn
authors.initials: P
authors.lastname: Chalermdamrichai
authors.forename: Siripen
authors.initials: S
authors.lastname: Puavilai
authors.forename: Suthep
authors.initials: S
authors.lastname: Jerasutus
authors.forename: Viboon
authors.initials: V
authors.lastname: Boonsarngsuk
authors.forename: Sumalee
authors.initials: S
authors.lastname: Kiattboonsri
authors.forename: Thitiporn
authors.initials: T
authors.lastname: Suwatanapongched
mesh_terms: D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D011239:Prednisolone / Q000627:therapeutic use; D011859:Radiography; D012507:Sarcoidosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D014382:Tuberculosis, Cutaneous / Q000175:diagnosis*
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone