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A Case for Diagnosis (Sarcoid? Lupus vulgaris?) Presented by Dr. Frank Post.
The patient is a 61-year-old accountant. Three months ago he noticed a small nodule on the inner portion of the right arm just above the elbow. It has enlarged into an elevated flat violaceous plaque with peripheral nodules and has been entirely asymptomatic. There is no history of trauma. He takes Serpasil for hypertension, colchicine and Benemid for gout, and Orinase for diabetes.
There is a deep purple, somewhat indurated plaque with satellite nodules and surrounding edema. Extending toward the right axilla and medial humeral condyle are hard cord-like subcutaneous indurations. There is no axillary lymphadenopathy.
The biopsy shows a deep granulomatous reaction. Extending into the subcutaneous fat, there are tubercles of epithelioid cells and some Langhans' giant cells surrounded by a moderately intense inflammatory reaction composed of small round and wandering connective tissue
Barker LP, Sachs W. NEW YORK DERMATOLOGICAL SOCIETY. Arch Dermatol. 1962;86(4):552–556. doi:10.1001/archderm.1962.01590100166030
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