Pulmonary Sarcoidosis

A 45-year-old African American man requested treatment of "keloids" that had developed 18 months earlier. The patient also reported dyspnea and exertion; there was no history of trauma.

Dr Ted Rosen of Houston found innumerable firm, hyperpigmented papules, plaques, and nodules on the patient's trunk, upper extremities, and neck. A biopsy disclosed dermal noncaseating granulomata. The an­giotensin-converting enzyme level was elevated, and chest films demonstrated hilaradenopathy and parenchymal infiltrates; these findings confirmed the diagnosis of pul­monary sarcoidosis.

Sarcoidosis is a systemic granulomatous disease that involves the respiratory tract in 88% of affected patients. It is most prevalent in persons between the ages of 20 and 40 years. Northern Europeans and blacks are most com­monly affected. In the United States, sarcoidosis occurs in 10.9 per 100,000 whites and 35.5 per 100,000 blacks.¹ This patient takes hydroxychloroquine, 200 mg bid; systemic corticosteroids are given for his infrequent exac­erbations of pulmonary symptoms. Although there is no cure for sarcoidosis, the disease can be adequately controlled in many patients with such combination therapy.

Sarcoidosis can closely mimic keloids; therefore, the granulomatous disease needs to be considered in the differential diagnosis of any cutaneous eruption in African Americans.

REFERENCE:

1. Amin NM. What's wrong with this picture? 26-year-old man with fever, erythematous nodules, and cough. Consultant. 2000;40:19531- 957.