ULCERATIVE SARCOIDOSIS - CASE-REPORT AND REVIEW OF THE LITERATURE

Background: Sarcoidosis is a chronic granulomatous multisystem disease of unknown origin. Cutaneous manifestations are common but ulcerative skin lesions rarely occur. We report a case of generalized ulcerative sarcoidosis in a patient with fatal multisystem involvement. A review of the literature revealed only 34 other cases of ulcerative sarcoido sis, 5 of which were generalized. We reviewed the clinicopathologic sp ectrum of the disease and available treatment options. Observations: U lcerative sarcoidosis affects women (23 of 35 cases) and blacks (18 of 30 cases) most commonly and occurs in young adulthood. Cutaneous sarc oid lesions, including ulcers (11 of 26 cases), were the presenting co mplaint in 26 of 35 cases. Ulcers developed both de novo and within ot her sarcoid lesions. The lower extremities were most often involved (2 9 of 35 cases). A histological diagnosis was made using skin biopsy sp ecimens in all cases. Corticosteroid therapy seems most effective for treatment of ulcerative sarcoidosis, with methotrexate a proven altern ative for refractory cases. Conclusions: Dermatologists most often mak e the initial diagnosis of sarcoidosis in patients with ulcerative les ions. In the proper clinical setting, a skin biopsy of ulcerative lesi ons establishes the diagnosis and prompt treatment reduces morbidity.