title: Sarcoidosis: An unusual presentation.
abstract: A 35-year-old man presented with a 3-year history of arthralgia and purple coloration of the skin of his fingers and feet. Hand and foot radiography showed cystic bone lesions on phalanges suggestive of sarcoidosis. Lab tests revealed increased liver enzymes. Liver MRI evidenced an enlarged liver and retroperitoneal lymphadenopathy. Histological analysis of the finger skin, lymph nodes and liver demonstrated the presence of granulomas, confirming the diagnosis of sarcoidosis. The patient started prednisolone with rapid improvement of the symptoms. Skin lesions are divided into two groups: specific for sarcoidosis (with granulomas, lupus pernio-like) and nonspecific (without granulomas, erythema nodosum-like). Specific cutaneous lesions usually cause no other symptoms beyond cosmetic changes. Lupus pernio stands out for having distinctive features but, to the best of our knowledge, the simultaneous involvement of both hands and feet has never been reported.
authors.affiliation: Rheumatology Department, Centro Hospitalar de São João, Porto, Portugal; Rheumatology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal. Electronic address: pmsmadureira@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Madureira
authors.affiliation: Rheumatology Department, Centro Hospitalar de São João, Porto, Portugal; Rheumatology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Pimenta
authors.affiliation: Gastrenterology Department, Centro Hospitalar de São João, Porto, Portugal.
authors.forename: Hélder
authors.initials: H
authors.lastname: Cardoso
authors.affiliation: Radiology Department, Centro Hospitalar de São João, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Guimarães Cunha
authors.affiliation: Rheumatology Department, Centro Hospitalar de São João, Porto, Portugal.
authors.forename: Lúcia
authors.initials: L
authors.lastname: Costa
mesh_terms: D000328:Adult; D001847:Bone Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D012507:Sarcoidosis / Q000175:diagnosis*; D012871:Skin Diseases / Q000175:diagnosis*
keywords: Bone lesions; Lesiones óseas; Lupus pernio; Sarcoidosis