Rheumatic disease in a Nigerian lady with sarcoidosis: Case report

Sarcoidosis is a rare disease. It is a systemic granulomatous disease that primarily affects the lungs and lymphatic systems of the body. It has not been reported in rheumatology practice in Nigeria. The essential factors for diagnosis include compatible clinicradiologic features, histologic proof of non-caseating epithelioid granulomas, and exclusion of similar diseases. The patient was a 63 year old lady who had a skin lesion overlying the upper lip. She developed cough which was associated with occasional chest pain. She had multiple joint pains, fever, oral ulcers and weight loss with associated anorexia. She developed significant hair loss, fatigue, redness of the eyes; with poor vision, and hearing impairment of about 6 years duration at the time of presentation. Essential findings were those of hearing impairment and a few crepitations in the lung bases. Her chest radiograph revealed bilateral hilar lymphadenopathy. The antinuclear antibody and anti double stranded DNA were both negative while serum angiotensin converting enzyme (sACE) was elevated (58.5IU). A punch biopsy of the skin overlying her upper lip revealed granulomatous dermatitis. Her electrolytes, urea and creatinine, liver function tests and full blood count were essentially normal.Key words: Sarcoidosis, Granulomatosis, Joint pains, Serum angiotensin converting enzym