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GEORGE J.HRUZAMDMICHAEL P.HEFFERNANMDSUMMER R.YOUKERMD
The patient, a 46-year-old black woman, was referred to the dermatology clinic at Washington University, St Louis, Mo, for evaluation of reddish-purple nodules on her face and shins. The patient’s medical history was significant for hypothyroidism and an arrhythmia. Findings from a punch biopsy from her right nasal ala showed confluent granulomas with central caseous necrosis in the dermis. Findings from a wedge biopsy specimen from her right shin showed granulomas in the dermis and subcutis with necrotizing foci. Acid-fast bacteria and Giemsa stains of both specimens were negative for mycobacteria and fungal organisms. Because of continued concern that she had an infection, an excisional biopsy specimen from the right leg was taken. Tissue culture for bacteria, mycobacteria, and fungi failed to grow any organisms. Histologic examination of this specimen revealed a septal panniculitis consistent with a diagnosis of erythema nodosum. Despite the caseating granulomas found on histologic examination of the specimens from the initial 2 biopsies, a diagnosis of sarcoidosis was made based on exclusion of an infectious etiology and the clinical appearance of the lesions.
Heffernan MP, Smith DI. Adalimumab for Treatment of Cutaneous Sarcoidosis. Arch Dermatol. 2006;142(1):17–19. doi:10.1001/archderm.142.1.17
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