Erythema nodosum-like lesion in sarcoidosis: a specific skin manifestation occasionally seen in Japanese patients

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Masato Ishikawa
Toshiyuki Yamamoto

Keywords

cutaneous sarcoidosis, specific lesion, lower extremity, erythema nodosum, ocular sarcoidosis

Abstract

Background: Erythema nodosum-like sarcoid lesion is a specific form of cutaneous sarcoidosis sometimes observed in Japanese patients, with a female predominance, involving the lower extremities. By contrast, erythema nodosum as a non-specific cutaneous manifestation associated with sarcoidosis is rare in Japan. Erythema nodosum-like sarcoid lesion resembles erythema nodosum only in appearance, but histologically shows sarcoid granulomas.


Objectives: To determine the clinical characteristics of erythema nodosum-like sarcoid lesion.


Methods: We examined the clinical characteristics of erythema nodosum-like sarcoid lesion in our patients with sarcoidosis. Clinical charts were retrospectively examined from 2000 to 2019. The patients’ data, such as age, gender, types of cutaneous lesion, serum levels of angiotensin-converting enzyme, and extracutaneous organ involvement, were evaluated. We also reviewed cases of erythema nodosum-like sarcoid lesion reported in previous literature.


Results: Among 101 cutaneous sarcoidosis patients, eight were diagnosed as having erythema nodosum-like sarcoid lesion in our department. The patients were one male and seven females, and their ages ranged from 30 to 74 years old. All cases involved the lower extremities. The serum angiotensin-converting enzyme level was elevated in five cases. Lung sarcoidosis was observed in all cases, and ocular sarcoidosis was observed in six cases, whereas no patients had cardiac sarcoidosis.


Conclusions: Although erythema nodosum-like sarcoid lesion may not be major skin manifestation of sarcoidosis, erythema nodosum-like sarcoid lesion frequently accompanies lung and ocular sarcoidosis. Thus, we should pay much attention to erythema nodosum-like sarcoid lesion for early identification of patients needing workup for systemic illness.

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References

1. Sakthivel P, Bruder D. Mechanism of granuloma formation in sarcoidosis. Curr Opin Hematol. 2017; 24: 59-65.
2. Rados J, Lipozencić J, Celić D, Loncarić D. Löfgren's syndrome presenting with erythema nodosum-like eruption. Acta Dermatovenerol Croat. 2007; 15: 249-253.
3. Okamoto H, Mizuno K, Imamura S, Nagai S, Izumi T. Erythema nodosum-like eruption in sarcoidosis. Clin Exp Dermatol 1994; 19: 507-510.
4. Takenoshita H, Yamamoto T. Erythema nodosum-like cutaneous lesions of sarcoidosis showing livedoid changes in a patient with sarcoidosis and Sjogren syndrome. Eur J Dermatol 2010; 20: 640-641.
5. Endo M, Yamamoto T, Chen KR. Sarcoid vasculitis presenting with erythema nodosum-like lesions. Sarcoidosis Vasc Diffuse Lung Dis. 2021; 38: e2021013.
6. Okamoto H. Cutaneous sarcoidosis. Nihon Rinsho. 2002; 60: 1801-1806 (in Japanese).
7. Yamamoto T. Characteristics of cutaneous sarcoid lesions in Japanese patients. Pract Dermatol. 2018; 40: 766-770 (in Japanese).
8. Jung YJ, Roh MR. Clinical and histopathological analysis of specific lesions of cutaneous sarcoidosis in Korean patients. J Dermatol Treat 2011; 22: 11-17.
9. James DG. Dermatological aspects of sarcoidosis. Q J Med 1959; 28: 108-124.
10. Grunewald J, Eklund A. Löfgren’s syndrome: human leukocyte antigen strongly influences the disease course. Am J Respir Crit Care Med 2009; 179: 307-312.
11. Spagnolo P, Sato H, Grunewald J, et al. A common haplotype of the C-C chemokine receptor 2 gene and HLA-DRB1*0301 are independent genetic risk factors for Löfgren’s syndrome. J Intern Med 2008; 264: 433-441.