A Case of Psoriasiform Sarcoidosis as Early Manifestation of Systemic Sarcoidosis

Sarcoidosis is a granulomatous disease with undetermined etiology, and shows variable skin manifestations. Although there have been numerous reports on cutaneous sarcoidosis, the early manifestations of systemic sarcoidosis are not clearly defined. Occurrence of both psoriasiform lesions and subcutaneous nodules in the same patient is rarely seen. A 39-year-old woman had psoriasiform lesions on her extremities for 1 year, and was treated with a topical steroid and calcipotriol ointment. One and half years after the initial skin lesions, pulmonary lesions were developed and treated with anti-tuberculosis medication for three months without any improvement. Since then, subcutaneous nodules on the upper extremities subsequently developed. Histopathological examination revealed non-caseous epithelioid granulomas in subcutaneous tissue and psoriasiform lesions. Furthermore, routine laboratory tests revealed anemia, leukopenia, hypercalcemia and elevated serum level of angiotensin converting enzyme (ACE), and chest X-ray revealed disseminated air space nodules on both lungs with non-segmental distribution. Considering initial poor response to anti-tuberculosis medication and subsequent good response to systemic steroid treatment, this condition was diagnosed as systemic sarcoidosis. Since we considered psoriasiform sarcoidosis as the early cutaneous manifestation of systemic sarcoidosis, we herein reported the caseope