以皮肤结节为首发表现的结节病2例

Two cases of sarcoidosis presenting with skin nodules as the first manifestation

报告2例以皮肤结节为首发表现,无明显呼吸系统症状,胸部CT均可见肺部多发结节与肿大淋巴结的结节病。患者1,女,47岁。因肘部、手指结节1个月就诊。皮肤科检查:右侧肘关节、左手食指、左手小拇指皮下可触及大小分别为0.8 cm×0.4 cm、0.9 cm×0.3 cm、0.5 cm×0.5 cm的红色、皮色结节,质硬,无压痛,边界清楚,局部皮温正常。左手小拇指皮肤结节组织病理示:表皮正常,真皮见上皮细胞肉芽肿部分呈裸结节,有纤维性包膜。胸部CT示:两肺多发结节,纵隔、肺门淋巴结肿大。诊断:结节病。患者2,女,44岁,因左下肢结节3个月就诊。皮肤科检查:左下肢胫前可见2枚大小分别为2.0 cm×2.0 cm、3.0 cm×2.0 cm的暗红色、皮色结节,左侧小腿后侧可见大小为4.0 cm×3.0 cm的皮色结节,质硬,无压痛,边界清楚,局部皮温正常。左下肢胫前皮肤结节组织病理示:表皮轻度增生,真皮浅层类上皮细胞及多核巨细胞浸润。胸部CT示:左肺下叶及右肺上叶、中叶多发结节灶;双肺马赛克灌注;右肺中叶、下叶少许纤维、钙化灶;纵隔淋巴结肿大伴钙化。诊断:结节病。2例患者均给予强的松30 mg/d口服治疗,2个月后激素逐渐减量,后随访1年,患者原皮疹均明显消退,无新发皮疹。

We report two cases of sarcoidosis presenting with skin nodules as the first manifestation,without prominent respiratory symptoms.Chest CT showed multiple pulmonary nodules and lymphadenopathy.Case 1,a 47-year-old female,presented with nodules on the elbows and fingers.Dermatological examination revealed demarcated,asymptomatic red and skin-colored nodules on the right elbow,and the index finger and the little finger of the left hand,sized 0.3 to 0.9 cm in diameter.Histopathology of the left pinky finger showed normal epidermis and epithelia granuloma with fibrous encapsulated naked tubercles in the dermis.Chest CT revealed bronchitis and multiple nodules in the both lungs,mediastinal and hilar lymphadenopathy.The diagnosis was sarcoidosis.Case 2,a 44-year-old female,complained of a 3-month history of nodules on the left lower limb.Dermatological examination showed two dark red and skin-colored nodules,sized 2.0 cm×2.0 cm and 3.0 cm×2.0 cm,respectively,on the anterior tibia of the left lower leg.A demarcated asymptomatic skin-colored nodule was observed on the posterior left lower leg.Histopathology of the left shin revealed mild epidermal hyperplasia and superficial dermal infiltrates of epithelioid cells and multinucleated giant cells.Chest CT revealed multiple nodules in the lower lobe of the left lung,upper and middle lobes of the right lung,mosaic perfusion of both lungs,a few fibers and calcifications in the middle and lower lobes of the right lung,mediastinal lymphadenopathy with calcification.Patients was diagnosed with sarcoidosis.Both patients were treated with oral prednisone acetate at 30 mg/d for 2 months,followed by a gradual reduction in glucocorticoid dose.No new rash was found after one-year follow-up.