A 45-year-old African American man requested treatment of "keloids" that had developed 18 months earlier. The patient also complained of dyspnea and exertion; there was no history of trauma.
Innumerable firm, hyperpigmented papules, plaques, and nodules were noted on the patient's trunk, upper extremities, and neck. A biopsy disclosed dermal noncaseating granuloma. The angiotensin-converting enzyme level was elevated, and chest films demonstrated hilar adenopathy 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(Drug information on hydroxychloroquine), 200 mg bid; systemic corticosteroids are given for infrequent exacerbations of his 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 and therefore needs to be considered in the differential diagnosis of any cutaneous eruption in African Americans.
(Case and photograph courtesy of Ted Rosen, MD.)
1. Amin N. What's wrong with this picture? 26-year-old man with fever, erythematous nodules, and cough. Consultant. 2000;40:1953-1957.