Photo-Induced Sarcoidosis
摘要
Corresponding author: Jen-Hung Yang, No. 110, Sec. 1, Jianguo N. Road, Taichung, Taiwan 402, R.O.C. TEL: 886-4-2473-9595 FAX: 886-4-2324-8116 E-mail: mryang@csmu.edu.tw Funding source: none Confl ict of interest: none declared Received: October 09, 2008 Revised: December 22, 2008 Accepted: February 11, 2009 CASE REPORT A 61-year-old woman, who was a farmer, suffered from fl esh to reddish annular skin rash over face, trunk and the extremities on and off for more than 20 years. The eruptions initially occurred on the face, and then involved the neck, chest, upper back and dorsal aspects of upper limbs indicating sunexposed areas. The lesions revealed as annular, erythematous, shiny-surfaced, infi ltrated papules or plaques (Fig. 1). The physical examination revealed no abnormal fi ndings on chest, and no lymphadenopathy was noted. The rash usually exacerbated after sunlight exposure 12 to 24 hours. The patient had no other systemic disease and denied taking medications which would cause photosensitivity. Laboratory studies including complete blood count, renal and liver function, serum calcium, angiotensin-converting enzyme, antinuclear antibody, Anti-extractable nuclear antigen antibodies, complement component 3, complement component 4, and serum immunoelectrophoresis were all within normal limits. Tuberculin purifi ed protein derivative (PPD) test revealed as a 20 mm in diameter indurated plaque. The histopathology of a papule on chest revealed dermal noncaseating granulomas composed of epithelioid cells and multinucleated giant cells and few lymphocytes (Fig. 2). Histochemical stains, including acid-fast, periodic acid-Schiff, alcian-blue, and elastica van Gieson stains, were negative. The pathological findings were compatible with cutaneous sarcoidosis. Further evaluations including the chest X-ray film, ophthalmologic examination, chest computed tomography (CT), abdominal sonography, and whole body gallium-67 scan revealed no systemic involvement. According to t