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(A) Skin impairment. Papulonodular skin lesions on the tip of the nose, from 3 to 10 mm, characteristic of sarcoidosis: firm, nonedematous, noninflammatory, nonpainful, nonpruriginous, with predominant facial involvement. (B) Endoscopic view (right nasal fossa) showing a major mucosae thickening. (C) Numerous uniform circumscribed nests of non-caseating granulomata which are characterized by the paucicity of lymphocytes and absence of necrosis.

Skin and Nasal Involvement: Look for Sarcoidosis!

  Sarcoidosis is a systemic, noncaseating, granulomatous disease affecting young adults between the ages of 25 and 40 years, most often of Black origin (35.5/100,000 vs 10.9 in the White population). Although the lower respiratory tract is affected in 90% of cases, ear, nose, and throat locations are very uncommon, with a prevalence varying between […]

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A, Single variably hypopigmented papule over the left upper eye. B, Multiple hyperpigmented maculopapular rash over the neck. C, Magnetic resonance imaging of the lumbosacral spine reveals a mottled appearance of the bone marrow on the T1-weighted images. D, CT scan of the chest reveals multiple scattered nodules over both lung fields uniformly distributed without any zonal preference. E, Multiple similar-appearing noncaseating epithelioid granulomas were observed on bone marrow biopsy.

The Great Masquerader Strikes Again!

To the Editor: A 42-year-old man presented with symptoms of severe low-back pain that was aggravated by activity and bending. He also reported sharp pains radiating down the back of the right thigh. In addition, he had an occasional mild cough with yellowish-gray sputum production. He denied any weight loss, night sweats, fevers, or chills. […]

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Axial (A), coronal (C), and parasagittal (D) computed tomography chest maximal intensity projections revealed innumerable spiculated soft-tissue nodules throughout the lungs, varying in size from 1 to 20 mm. Although the majority are centrilobular, there are some based on the pleura and within fissures, highlighted in the parasagittal slice (D). They are well defined and not typical of hypersensitivity pneumonitis. The nodules were variably avid on positron emission tomography scan (B).

Necrotizing Sarcoid Granulomatosis: Clinico-Radio-Pathologic Diagnosis

A 30-year-old man was referred to the rheumatology outpatient department and seen urgently after developing diplopia over a 4- to 8-hour period and an isolated left fourth cranial nerve palsy associated with a bifrontal and left temporal headache and episodic vertigo. Magnetic resonance imaging of the brain at that time was unremarkable. The following week […]

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The third portion of the duodenum: flattened folds.

Screening of Celiac Disease in Patients With Sarcoidosis?

Sarcoidosis and celiac disease (CD) are both autoimmune disorders, which have been associated with class II haplotype HLA-DR3, DQ2. Literature demonstrates this combination is more prevalent in the Irish population.1 Celiac disease is caused by the ingestion of gluten, where the predisposed population (HLA BQ2 or BQ8 carriers) develop antibodies against gluten peptides. The prevalence of […]

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House Afire

Like a House Afire: Cardiac Sarcoidosis  It seemed like an obvious case of acute coronary syndrome—but was it really? A 36-year-old man of Sri Lankan origin presented to his local rural emergency department with severe central chest pain. He described persistent chest tightness radiating to his left arm. This had developed at rest and was […]

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