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La sarcoidosis es una enfermedad multisistémica, caracterizada por la presencia de granulomas no caseosos. Presentamos a un hombre de 26 años que acude al servicio de urgencias por fiebre, mialgias, hipersudoración y pérdida de peso. En el análisis se observa pancitopenia, velocidad de sedimentación aumentada y enzima convertidora de angiotensina >150 U/L; esplenomegalia, adenopatías retroperitoneales peri aórtico-cava confirmadas por imagenología. Tras excluir las causas más frecuentes, hizo un lavado bronco alveolar con una proporción elevada de CD4/CD8 y linfocitosis superior al 50%, así como granulomas epitelioides confluentes no caseosos en la biopsia de adenopatía, estableciendo el diagnóstico de sarcoidosis en estadio III.

Abstract Background Although traditionally used for the diagnosis of skin tumors, in the past few years dermoscopy as a clinical diagnostic aid for inflammatory and infectious skin manifestations has also received more and more attention. The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Dermoscopy can be used as an auxiliary examination method. Objective Our aim was to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of CS. Methods This was a retrospective analysis of 39 CS clinical and dermoscopic images collected in the Department of Dermatology, Huashan Hospital Affiliated with Fudan University from August 2013 to February 2021. Results Retrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures in all 39 cases. Variable diameter linear vessels were found in 38 cases. A central scar-like area was seen in 26 cases. Bright white streaks were seen in 30 cases. The follicular plugs were seen in 15 cases. Study limitations First, the number of cutaneous sarcoidosis cases the authors collected is small. Second, due to the lack of a control group, the sensitivity and specificity of the proposed criteria were not calculated. Finally, since our study mainly includes suspicious lesions that were biopsied for diagnostic purposes, there may be a selection bias. Conclusion Lesions showing on dermoscopy grouped translucent orange ovoid structures associated with linear vessels should raise the suspicion of CS. Central scar-like areas and bright white streaks are also helpful in the diagnosis of CS.

Abstract Background: Erythema Nodosum (EN) is the most common skin manifestation in sarcoidosis and has often been associated with a good prognosis. Objectives: To compare the clinical characteristics and treatment-related features in patients with sarcoidosis according to whether or not EN was seen as a presenting symptom at the time of diagnosis. Methods: A 20-year single-center retrospective study was performed. The following two groups were identified: one group with EN as one of the presenting symptoms at the time of diagnosis of sarcoidosis (EN group) and a second group without EN as a presenting symptom at diagnosis (non-EN group). The clinical characteristics and treatment modalities were collected from the medical records. Results: A total of 122 patients (31 in the EN group, 91 in the non-EN group) were included. Radiological stages of pulmonary disease were significantly lower in the EN group. Articular involvement was more common in the EN group (p = 0.001), whereas other systemic organ involvements (p = 0.025), especially neurological involvement (p = 0.036), were significantly more common in the non-EN group. In the EN group, a higher percentage of patients were managed without systemic therapy (71.0% vs. 54.9%) and spontaneous remission was more frequent (25.0% vs. 14.1%), however, this wasn’t statistically significant. Study limitations: Retrospective design. Conclusions: The lower radiological stage of pulmonary sarcoidosis and lower frequency of systemic organ involvement in patients with EN augment the prognostic value of EN highlighted in the literature. However, this study couldn’t confirm that the patients with EN would need less systemic therapy in the course of their disease.

Abstract The skin demonstrates what is happening in the body in many diseases, as it reflects some internal processes on the surface. In this sense, skin as an organ, goes beyond its protective and barrier functions, as it provides clues for the identification of some systemic diseases. The dermatologist then raises diagnostic hypotheses for conditions related to all systems and refers them to the appropriate specialty. With easy access to examination by trained eyes and biopsies, the skin can present specific or non specific alterations on histopathology. In the first case this combination establishes the diagnosis of the disease itself. Non specific manifestations can occur in a variety of contexts and then histopathology is not specific of a particular disease. This article is divided into two parts that will cover large groups of diseases. In this first part, cutaneous manifestations of the main rheumatologic diseases are described, which are the ones with the greatest interface with dermatology. The authors also talk about vascular manifestations and granulomatous diseases. In the second part, endocrinological, hematological, oncological, cardiovascular, renal, gastrointestinal diseases, pruritus and its causes are discussed, and finally, the dermatological manifestations of SARS-CoV-2 coronavirus infection. The authors’ intention is that, by using direct and easily accessible language, aim to provide practical material for consultation and improvement to all dermatologists who recognize the importance of a comprehensive assessment of their patients.

Sarcoidosis is a chronic multisystemic disease of unknown etiology, characterized by the formation of non-caseous granulomas, most commonly with lung, intrathoracic lymph node, skin and ocular involvement. We present the case of a 69-year-old male with hyperthyroidism due to a toxic nodule who underwent a thyroidectomy but kept losing weight. Afterwards he developed photopsias, hepatosplenomegaly and pancytopenia. Exams revealed non-caseous granulomatous involvement of thyroid, eye, liver and bone marrow. Corticosteroid therapy was initiated with overall improvement. This case illustrates an infrequent case of sarcoidosis with exclusive extra-thoracic disease, highlighting the rare bone marrow and thyroid involvement causing an unspecific presentation.

Sarcoidosis is a systemic granulomatous disease with skin involvement in 10% to 25% of cases.This skin condition has been associated with previous trauma, including the use of skin fillers.We present the case of a patient with an erythematous plaque on the nasal dorsum with 12 months of evolution and a history of previous facial fillings with polymethylmethacrylate and hyaluronic acid. Skin biopsy showed a granulomatous inflammatory process with an epithelioid pattern and multinucleated giant cells, characteristic of cutaneous sarcoidosis. Sarcoidosis can occasionally manifest without systemic involvement and may be associated with the previous use of long-term tissue fillers.

Selective immunoglobulin M deficiency (SIgMD) is a rare primary immunodeficiency characterized by decreased serum levels of immunoglobulin M. The pathogenesis of SIgMD is unclear, as well as its association with various immunopathological disorders. We describe a case of sarcoidosis associated with SIgMD. To our knowledge, such association has not been reported previously.

Abstract Background: Sarcoidosis is a multisystem disease of unknown cause that is characterized by the presence of granulomas in various organs. Cutaneous involvement is common and the reported incidence has varied from 9% to 37%. Studies on cutaneous sarcoidosis in Brazil are lacking. Objectives: To describe the clinical and epidemiological aspects of patients with cutaneous sarcoidosis diagnosed at the Department of Dermatology of the University of São Paulo, from May 1994 to March 2018. Methods: Clinical data of patients with confirmed cutaneous sarcoidosis were retrospectively reviewed and classified according to gender, ethnicity, age at diagnosis, cutaneous presentation, systemic involvement and treatment. Results: Cutaneous sarcoidosis was diagnosed in 72 patients with a female predominance (74%). The mean age at diagnosis was 49.6 years and most of the patients were white (61%). Papules and plaques were the most common lesions. Systemic sarcoidosis was detected in 81% of patients, affecting mainly the lungs and thoracic lymph nodes (97%). Typically, cutaneous lesions were the first manifestation (74%). Systemic therapy was necessary for 72% of patients; the dermatologist managed many of these cases. Oral glucocorticoids were the most commonly used systemic medication (92%). The mean number of systemic drugs used was 1.98 per patient. Limitations: Insufficient data in medical records. Conclusions: This series highlights the dermatologist role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement and treating the skin manifestations. Cutaneous sarcoidosis was once considered exceedingly infrequent in Brazil in comparison to infectious granulomatous diseases; however, the present series seems to suggest that the disease is not so rare in this region.

Sarcoidosis is a chronic granulomatous disease, of unknown etiology, affecting multiple organs and tissues. The respiratory system is the most commonly affected, followed by skin manifestations. However, oral cavity presentation is rare, with approximately 70 cases reported in the literature. An oral presentation can range from asymptomatic conditions to ulcerations with a risk of secondary infection, which compromise the patient's quality of life. Although rare, cases of sarcoidosis with impairment of the oral cavity may present an unfavorable clinical evolution, or even present as an initial clinical manifestation from a systemic condition. Therefore, it is important to assist in the recognition, diagnosis, and appropriate treatment of this disease.

A 47-year-old man, obese, without medical problems, presented with a 15-day history of painful erythematous nodular lesions on the anterior side of lower limbs. He had no improvement with antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). He developed migratory and symmetric arthralgias (ankles, knees, elbows) and low-grade fever. The skin lesions progressed to the upper limbs. On physical examination, a mild swelling and tenderness in both ankles was noted, and lesions suggestive of erythema nodosum were seen.[...]

Abstract Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology. Cutaneous involvement occurs in up to 30% of patients and skin findings are often the initial presenting symptom. The facial atrophic form of sarcoidosis without associated ulceration in adolescents has rarely been described in the literature. We report a case of 13-year-old male patient with a facial atrophic sarcoidosis who was successfully treated with the combination of prednisone and hydroxychloroquine.

ABSTRACT Objective: Evaluation of enlarged mediastinal lymph nodes is crucial for patient management. Malignant lymphoma and sarcoidosis are often difficult to differentiate. Our objective was to determine the diagnostic accuracy of MRI for differentiating between sarcoidosis and malignant lymphoma. Methods: This was a retrospective study involving 47 patients who underwent chest MRI and were diagnosed with one of the diseases between 2017 and 2019. T1, T2, and diffusion-weighted signal intensity were measured. Apparent diffusion coefficients (ADCs) and T2 ratios were calculated. The diagnostic performance of MRI was determined by ROC analysis. Results: Mean T2 ratio was significantly lower in the sarcoidosis group than in the lymphoma group (p = 0.009). The T2-ratio cutoff value that best differentiated between lymphoma-related and sarcoidosis-related enlarged lymph nodes was 7.1, with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 58.3%, 95.6%, 76.5%, 93.3%, and 68.7%, respectively. The mean ADC was significantly lower in the lymphoma group than in the sarcoidosis group (p = 0.002). The ADC cutoff value that best differentiated between lymphoma-related and sarcoidosis-related enlarged lymph nodes was 1.205, with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 87.5%, 82.6%, 85.1%, 84.0% and 86.3%, respectively. No significant differences were found between the two groups regarding T1 signal intensity, T2 signal intensity, and lymph node diameter. Conclusions: MRI parameters such as ADC, diffusion, and T2 ratio can be useful in the differentiation between sarcoidosis and lymphoma in the evaluation of enlarged lymph nodes.

Sarcoidosis is a multisystemic noncaseating granulomatous disease of unknown etiology. Cardiac sarcoidosis clinical presentation is diverse, and syncope is one of the possible primary events. Due to its variable natural history and initial presentation associated with lacking sensitive and specific diagnostic tests, it still represents a challenging diagnosis. This article presents the case of a 51-year-old female patient with intermittent syncope events associated with torsades de pointes and dilated cardiomyopathy compatible with sarcoidosis.

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Abstract: Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.

Abstract: Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that allows visualization of the epidermis and papillary dermis with cellular-level resolution. Granulomatous reactions such as sarcoidosis could be assessed using RCM. The identification of bright beaded-like structures that could correspond to reticulin fibers overlying granulomas, in association with dermoscopy, may be a very useful approach in the diagnosis of sarcoidosis and for the differentiation of this granulomatous entity with superficial cutaneous metastasis.

Abstract: Molecular studies have shown more than one species of the genus Paracoccidioides to be the causal agent of paracoccidioidomycosis. Efforts have been made to correlate the identified species with epidemiological and clinical data of patients, aiming to determine the real meaning and impact of new species. Bearing this objective in mind, the authors report a clinical case of paracoccidioidomycosis, from São Paulo state, Brazil, that manifested as uncommon sarcoid-like cutaneous lesions and was caused by Paracoccidioides brasiliensis sensu stricto (S1a). The patient was treated with itraconazole 200mg/day for 12 months, with complete clinical remission.

Abstract Numerous infectious, inflammatory and neoplastic complications secondary to tattoo placement have been reported in the literature. Within inflammatory complications sarcoidal granulomatous reactions have been described. We report two cases, a 55-year-old woman with yellowish infiltrated plaques on bilateral ciliary region, 16 years after the placement of a permanent tattoo in the eyebrows, and a 20-year-old tattoo artist who developed orange papules on 3 of his tattoos. Histopathology in both cases confirmed diagnosis of sarcoidal granulomatous reaction due to tattoo pigment.

Mujer de 61 años con granulomatosis orocial, diagnosticada 40 años después de su debut.

Abstract Sarcoidosis is a disease which still has uncertain etiology. Possible environmental causes are cited in the literature, like organic and inorganic particles and infectious agents. Recent studies have demonstrated the occurrence of sarcoidosis in patients with chronic C hepatitis; however, this association remains without statistical or causal evidence. In this report a case of sarcoidosis associated with chronic hepatitis C will be described, with subcutaneous lesions, considered rare, and good response to treatment with colchicine and prednisone. The hepatitis C virus was isolated in sarcoid tissue and the association between the two diseases will be discussed.

A 4-year-old Criollo stallion was presented at the equine clinic of veterinary hospital of the Federal University of Santa Maria, RS, with a 30-day history of progressive weight loss, anemia and swelling of the forelimbs and face. Physical examination revealed that the swelling was firm and had a bone-like consistency, also radiographs showed extensive periosteal proliferation on the forelimb long bones that suggested hypertrophic osteopathy (Marie´s disease). Physical examinations identified no respiratory findings. However, during ultrasound examination, superficial lung disease was identified. The animal was treated with antibiotics and nonsteroidal anti-inflammatory drugs for 12 days. Due to a complete lack of response to this treatment, the horse was euthanized. At necropsy several granulomatous lesions were identified in the thorax, abdomen and testicular tunics. Bony proliferation was evident on many bones of the appendicular skeleton and face. Based on these findings the diagnosis of hypertrophic osteopathy associated with sarcoidosis was established. It is important to perform a thorough clinical examination and include hypertrophic osteopathy in the differential diagnosis of diseases that are accompanied by swelling of the face and limbs as edema from various causes, fibrous osteodystrophy, for example. Key words: Pulmonary. Periosteal. Sarcoidosis. Pathology

Abstract The current report presents the case of a 41-year-old male patient with a two-month history of asthenopia and plaques in the frontotemporal region. Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure. Skin biopsy demonstrated aa dermal inflammatory infiltrate composed mainly of epithelioid cells and a few multinucleated giant cells, but no obvious lymphocytes. Findings of thorough physical examinations and auxiliary examinations suggested the presence of cutaneous sarcoidosis and secondary open-angle glaucoma. Treatment consisted mainly of oral methylprednisolone. Skin lesions, bilateral hilar, and mediastinal lymphadenopathy resolved completely. Cutaneous sarcoidosis is often accompanied by extracutaneous organ involvement. Dermatologists must be aware of the disease's extracutaneous manifestations to ensure accurate diagnosis for further treatments.

OBJETIVO: Investigar o significado de marcadores de imunidade celular e de componentes elásticos/colágeno da matriz extracelular em estruturas granulomatosas em biópsias de pacientes com sarcoidose pulmonar ou extrapulmonar. MÉTODOS: Determinações qualitativas e quantitativas de células inflamatórias, de fibras de colágeno e de fibras elásticas em estruturas granulomatosas em biópsias cirúrgicas de 40 pacientes com sarcoidose pulmonar e extrapulmonar foram realizadas por histomorfometria, imuno-histoquímica, e técnicas de coloração com picrosirius e resorcina-fucsina de Weigert. RESULTADOS: A densidade de linfócitos, macrófagos e neutrófilos nas biópsias extrapulmonares foi significativamente maior do que nas biópsias pulmonares. Os granulomas pulmonares apresentaram uma quantidade significativamente maior de fibras de colágeno e menor densidade de fibras elásticas que os granulomas extrapulmonares. A quantidade de macrófagos nos granulomas pulmonares correlacionou-se com CVF (p < 0,05), ao passo que as quantidades de linfócitos CD3+, CD4+ e CD8+ correlacionaram-se com a relação VEF1/CVF e com CV. Houve correlações negativas entre CPT e contagem de células CD1a+ (p < 0,05) e entre DLCO e densidade de fibras colágenas/elásticas (r = -0,90; p = 0,04). CONCLUSÕES: A imunofenotipagem e o remodelamento apresentaram características diferentes nas biópsias dos pacientes com sarcoidose pulmonar e extrapulmonar. Essas diferenças correlacionaram-se com os dados clínicos e espirométricos dos pacientes, sugerindo que há duas vias envolvidas no mecanismo de depuração de antígenos, que foi mais eficaz nos pulmões e linfonodos.OBJECTIVE: To investigate the significance of cellular immune markers, as well as that of collagen and elastic components of the extracellular matrix, within granulomatous structures in biopsies of patients with pulmonary or extrapulmonary sarcoidosis. METHODS: We carried out qualitative and quantitative evaluations of inflammatory cells, collagen fibers, and elastic fibers in granulomatous structures in surgical biopsies of 40 patients with pulmonary and extrapulmonary sarcoidosis using histomorphometry, immunohistochemistry, picrosirius red staining, and Weigert's resorcin-fuchsin staining. RESULTS: The extrapulmonary tissue biopsies presented significantly higher densities of lymphocytes, macrophages, and neutrophils than did the lung tissue biopsies. Pulmonary granulomas showed a significantly higher number of collagen fibers and a lower density of elastic fibers than did extrapulmonary granulomas. The amount of macrophages in the lung samples correlated with FVC (p < 0.05), whereas the amount of CD3+, CD4+, and CD8+ lymphocytes correlated with the FEV1/FVC ratio and VC. There were inverse correlations between TLC and the CD1a+ cell count (p < 0.05), as well as between DLCO and collagen/elastic fiber density (r = -0.90; p = 0.04). CONCLUSIONS: Immunophenotyping and remodeling both showed differences between pulmonary and extrapulmonary sarcoidosis in terms of the characteristics of the biopsy samples. These differences correlated with the clinical and spirometric data obtained for the patients, suggesting that two different pathways are involved in the mechanism of antigen clearance, which was more effective in the lungs and lymph nodes.

Sarcoidosis is a granulomatous disease of unknown etiology. The skin is commonly affected. Cutaneous manifestations can mimic other diseases and autoimmune disorders. The dermatologist plays a critical role in elucidating the clinical diagnosis and assisting other specialists in the investigation of a systemic disease. We report a patient with typical cutaneous manifestation of sarcoidosis with pulmonary involvement.A sarcoidose é uma doença granulomatosa de etiologia desconhecida. A pele é comumente afetada. As manifestações cutâneas podem mimetizar outras afecções e desordens auto-imunes. Assim, o dermatologista assume papel fundamental para elucidar o diagnóstico clínico e auxiliar outros especialistas na investigação de uma doença sistêmica. Relatamos um caso de paciente com manifestação cutânea típica de sarcoidose associada com acometimento pulmonar.

Abstract: Heerfordt-Waldenström syndrome is a rare subacute variant of sarcoidosis, characterized by enlargement of the parotid or salivary glands, facial nerve paralysis and anterior uveitis. Granulomas with a peripheral lymphocyte deficit are found in the anatomic pathology of affected organs. It is normally self-limiting, with cure achieved between 12 and 36 months, but some prolonged cases have been reported. Diagnosis of the syndrome is clinical, and treatment depends on the degree of systemic impairment. Oral corticosteroids represent the first line treatment option. The mortality rate ranges between 1 and 5% of cases.

OBJETIVO: Analisar as características epidemiológicas de pacientes com sarcoidose na cidade do Rio de Janeiro. MÉTODOS: Estudo descritivo, caso-controle, envolvendo 100 pacientes com sarcoidose acompanhados no Hospital Universitário Pedro Ernesto, localizado na cidade do Rio de Janeiro, entre 2008 e 2010. O diagnóstico de sarcoidose foi baseado em critérios clínicos, radiográficos, laboratoriais e histopatológicos. RESULTADOS: A doença predominou em mulheres (65%), na faixa de 35-40 anos (variação: 7-69 anos), embora houvesse um segundo pico na população de aproximadamente 55 anos. A dispneia foi o sintoma mais comum (47%), assim como o achado radiográfico de comprometimento pulmonar e linfonodal (estágio II; 43%), seguido por estágio III (20%), estágio 1(19%), estágio 0 (15%) e estágio IV (3%). Nenhum paciente apresentou derrame pleural ou baqueteamento digital no diagnóstico. O PPD foi não reator em 94 pacientes. Os achados espirométricos no diagnóstico foram normais em 61 pacientes; indicativos de distúrbio ventilatório obstrutivo, em 21; e indicativos de distúrbio ventilatório restritivo, em 18. Os sítios de biópsia mais comuns foram os pulmões (principalmente por broncoscopia) e a pele, que confirmaram o diagnóstico em 56% e 29% dos casos, respectivamente. O tratamento com prednisona foi iniciado em 75% dos pacientes e mantido por mais de 2 anos em 19,7%. CONCLUSÕES: Este estudo corrobora vários achados relatados em outros estudos sobre as características epidemiológicas de pacientes com sarcoidose.OBJECTIVE: To analyze the epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil. METHODS: A descriptive, case-control study involving 100 sarcoidosis patients under outpatient treatment between 2008 and 2010 at the Pedro Ernesto University Hospital, located in the city of Rio de Janeiro, Brazil. The diagnosis of sarcoidosis was based on clinical, radiological, biochemical, and histopathological criteria. RESULTS: There was a predominance of females in the 35-40 year age bracket (range, 7-69 years), who accounted for 65% of the sample, although there was a second peak at approximately 55 years of age. The most common symptom was dyspnea (in 47%), and the most common radiological findings were pulmonary and lymph node involvement (stage II; in 43%), followed by stage III (in 20%), stage I (in 19%), stage 0 (in 15%), and stage IV (in 3%). No pleural effusion or digital clubbing was observed at diagnosis. The tuberculin skin test was negative in 94 patients. Spirometric findings at diagnosis were normal in 61 patients; indicative of obstructive lung disease in 21; and indicative of restrictive lung disease in 18. The most common biopsy sites were the lungs (principally by bronchoscopy) and the skin, the diagnosis being confirmed by biopsy in 56% and 29% of the cases, respectively. Treatment with prednisone was initiated in 75% of the patients and maintained for more than 2 years in 19.7%. CONCLUSIONS: This study corroborates the findings of previous studies regarding the epidemiological characteristics of sarcoidosis patients.

FUNDAMENTO: Sarcoidose é uma doença granulomatosa multissistêmica de origem desconhecida que pode causar morte súbita. OBJETIVO: Avaliação eletrofisiológica de pacientes com sarcoidose com suspeita de comprometimento cardíaco. MÉTODOS: Foram estudados 22 pacientes com média de idade de 55,32 ±13,13 anos, com diagnóstico de sarcoidose e suspeita de comprometimento cardíaco. Foram submetidos à avaliação clínica, exames laboratoriais, eletrocardiograma, ecocardiograma, Holter de 24h, cintilografia com gálio ou tecnécio e estudo eletrofisiológico. Em casos selecionados foi realizada tomografia por emissão de pósitrons ou ressonância magnética. Os pacientes foram seguidos ambulatoriamente com consultas trimestrais. RESULTADOS: Comprometimento cardíaco foi comprovado em quatro (18,2%) pacientes. Extrassístoles ventriculares com densidade > 100/24h foram documentadas no Holter de 24h em 12 (54,5 %) pacientes. O estudo eletrofisiológico revelou aumento do intervalo HV em sete (31,8%) e ponto de Wenckebach aumentado em quatro (18,2%) pacientes. Houve indução de fibrilação atrial em sete (31,8%) e de taquicardia ventricular sustentada em um (4,5%). Nos quatro pacientes com sarcoidose cardíaca confirmada, extrassístoles ventriculares, com densidade > 100/24h foram documentadas em todos, dois apresentavam intervalo HV prolongado e fibrilação atrial foi induzida em dois. Taquicardia ventricular sustentada não foi induzida em nenhum desses pacientes. Após período médio de acompanhamento de 20,9 ± 15,7 meses, um paciente com sarcoidose cardíaca apresentou morte súbita. CONCLUSÃO: Pacientes com sarcoidose e suspeita de envolvimento cardíaco apresentam alta prevalência de EVs e distúrbios do sistema de condução.

Sarcoidosis is a multisystem granulomatous disease of unknown cause. The osteoarticular involvement in sarcoidosis is rare and is often associated with cutaneous and long-standing chronic multisystem disease. More common in black women, osseous sarcoidosis is difficult to diagnose, with an incidence of 3 to 13%. The most characteristic radiological clinical picture evidences rounded, well-defined cysts, with no periosteal reaction and without peripheral sclerosis. The small bones of hands and feet are the most frequently involved sites. This report aims to demonstrate a rare case of osteoarticular sarcoidosis with characteristic clinical presentation, and highlight the importance of detecting osteoarticular involvement in this pathology.

Os autores apresentam um caso clínico de uma doente de 41 anos a quem foi efectuado o diagnóstico de sarcoidose com base em manifestações clínicas nasais e laríngeas. Os autores fazem uma breve revisão bibliográfica sobre as manifestações clínicas da sarcoidose em ORL, nomeadamente no que concerne ao diagnóstico, terapêutica e prognóstico desta entidade clínica.The authors present the case of a 41-year-old woman with nasal and laryngeal involvement by sarcoidosis, review the literature and discuss the otolaryngologic manifestations, the diagnostic evaluation, treatment and prognostic of this entity.

The antagonists of tumor necrosis factor alpha (TNF-α) are increasingly being used in the treatment of inflammatory and autoimmune diseases. Several adverse effects of these drugs have been reported, including the paradoxical development of sarcoidosis, especially with the use of etanercept. We present the first Brazilian case report of systemic sarcoidosis induced by etanercept and a literature review.

The paradoxical adverse effects of tumor necrosis factor-alpha (TNF-alpha) antagonists have been described frequently as a result of the widespread use of these drugs. Among the TNF-alpha blocking agents, few reports exist relating the use of adalimumab in cutaneous sarcoidosis, although all of them show good results. More recently, sarcoidosis onsets have been reported with various TNF-alpha inhibitors. The current case is, to our knowledge, the first to describe the exacerbation of cutaneous lesions of sarcoidosis treated with adalimumab.

A sarcoidose é uma doença sistêmica de etiologia desconhecida, caracterizada pela inflamação crônica granulomatosa, que acomete com maior frequência os pulmões, a pele e os olhos e, muito raramente, detectamos envolvimento renal na patologia. Relatamos aqui o caso de uma paciente de 47 anos, branca, internada em uma unidade de emergência de Hospital Universitário, devido a sintomas e achados radiológicos sugestivos de pneumonia. Desde o início da internação ela se apresentava com quadro laboratorial de insuficiência renal aguda, inicialmente atribuída ao histórico recente de uso abusivo de anti-inflamatórios. No entanto, devido à evolução arrastada e aparentemente desfavorável, inclusive com necessidade de terapia renal substitutiva (TRS), a paciente foi submetida a uma biópsia renal para esclarecimento diagnóstico e avaliação prognóstica. A descrição histológica mostrava um quadro de nefrite intersticial aguda granulomatosa, característico de sarcoidose renal, diagnóstico confirmado após revisão do prontuário médico, que revelava internação anterior devido a evento pulmonar da doença. Iniciado tratamento com prednisona 1 mg/kg/dia, a paciente evoluiu com melhora do quadro de insuficiência renal aguda, não mais necessitando de TRS. Atualmente, a paciente é mantida em acompanhamento ambulatorial com função renal estável.Sarcoidosis is a systemic disease of unknown etiology, characterized by chronic granulomatous inflammation, which affects most frequently the lungs, skin, and eyes, and most rarely the kidneys. We report the case of a 47-year-old, white, woman admitted to the emergency unit of a university-affiliated hospital due to symptoms and radiologic findings suggestive of pneumonia. Since the beginning, her laboratory tests showed acute renal failure, initially attributed to the recent history of abuse of anti-inflammatory drugs. However, because of her protracted and apparently unfavorable evolution, requiring renal replacement therapy (RRT), she underwent renal biopsy for diagnosis and prognostic assessment. Histology showed acute granulomatous interstitial nephritis, characteristic of renal sarcoidosis, which was confirmed after review of the medical record disclosing a previous admission due to lung involvement of the disease. Treatment with prednisone (1mg/kg/day) was initiated, acute renal failure improved, and the patient no longer required RRT. Currently she is followed up on an outpatient service, and her renal function is stable.

A apresentação clínica da sarcoidose e diversa e em mais de 90% dos casos existe envolvimento pulmonar. Os achados radiológicos mais frequentes aquando do diagnostico são a presença de adenopatias hilares e infiltrados pulmonares. Os autores apresentam o caso de uma doente jovem cuja radiografia torácica apresentava múltiplos nódulos bilaterais. A biopsia cirúrgica revelou a presença de granulomas nao necrotizantes com células gigantes multinucleadas, compatível com sarcoidose. Apesar de se tratar de uma sarcoidose pulmonar estádio III, a doente apresentava -se assintomática, o estudo funcional ventilatorio era normal e não havia sinais de envolvimento extratoracico, pelo que foi decidido não iniciar tratamento. Houve remissão espontânea das lesões, comprovada em tomografia computorizada de alta resolução após um ano.The clinical presentation of sarcoidosis is diverse and in over 90% of patients there is pulmonary involvement. The most common features of the radiographic findings at the time of diagnosis are bilateral hilar lymphadenopathy and pulmonary infiltration. The authors report the case of a young female patient who presented with multiple bilateral nodular shadows on chest radiograph. Surgical biopsy revealed non-necrotizing granulomas with occasional multinucleated giant cells compatible with sarcoidosis. Al-though this was a case of stage III pulmonary disease, the patient was asymptomatic, lung function tests were normal and there were no signs of extrathoracic involvement. Spontaneous remission occurred without treatment as shown on high resolution CT scan follow-up, one year later.

A alveolite alérgica extrínseca e a sarcoidose são ambas doenças granulomatosas pulmonares que se caracterizam pela presença de granulomas não necrotizantes. Ambas apresentam alterações típicas no lavado broncoalveolar, com relações CD4/CD8 opostas. No entanto, a sarcoidose não apresenta hoje em dia factores etiológicos bem definidos, como a alveolite alérgica extrínseca. As autoras apresentam dois casos clínicos com curso clínico, imagiológico, funcional e imunológico semelhante, embora com confirmação histopatológica não concordante com as alterações do LBA e com a particularidade de pertencerem a dois elementos da mesma família, convivente, e de terem surgido com poucas semanas de intervalo.Extrinsic allergic alveolitis and sarcoidosis are two granulomatosis of the lung characterized by non-necrotizing granuloma. Both have typical bronchoalveolar lavage immunology, with opposite CD4/CD8 relation. However, sarcoidosis does not have such well defined etiology as extrinsic allergic alveolitis. The authors present two cases with similar clinical course, imagiology, lung function and immunology, although they both had an histology that was not concordant with the bronchoalveolar lavage, and with the peculiarity of being two elements of the same family, co -inhabitants and with a clinical presentation only a few weeks apart.

Introdução: A susceptibilidade genética na ocorrência da sarcoidose é sugerida por alguns factores, nomeadamente pela observação de casos de agregação familiar e a associação da raça a diferentes tipos de incidência e gravidade da doença. Vários estudos têm evidenciado a associação da classe I e especialmente da classe II do sistema HLA com a susceptibilidade à sarcoidose. Objectivos: Estudo dos polimorfismos genéticos da classe I e II do sistema HLA e do TNF -á num grupo de doentes com sarcoidose, nomeadamente a sua influência na susceptibilidade, apresentação clínica e evolução da doença. Material e métodos: Foram incluídos 104 doentes com sarcoidose, tendo sido estudadas a apresentação clínica, funcional, radiológica e os resultados do LBA. Foram usados métodos de biologia molecular na genotipagem do HLA -A*, B*, C*, DRB1*, DQB1* e TNF -á. O ADN foi extraído do sangue periférico e foram usados os métodos PCR -SSP e PCR -reverse hibridization. As frequências alélicas foram comparadas com controlos da mesma região geográfica pelo teste ÷2, sendo usado o teste Kruskal -Wallis para variáveis contínuas. Resultados: Comparativamente com os controlos, os doentes incluídos apresentavam frequências aumentadas de: B*08 (10,6% vs 6,1%), OR=1,8, IC=[1,1;3,1], p=0,02; DRB1*12 (4,3% vs 1,7%), OR=2,63, IC=[1,1;6,1], p=0,03. Os doentes com eritema nodoso apresentaram aumento das frequências alélicas de DRB1*03 (28% vs 9,3%), RR=2,39, IC=[1,5;3,8], pc=0,01 e DQB1*02 (38% vs 18%), RR=2,1, IC=[1,3;3,3], pc=0,02. O alelo DQB1*03 está diminuído nos doentes que apresentam síndroma ventilatória obstrutiva, RR=0,53, IC=[0,3;0,9],pc=0,05. O alelo DRB1*15 encontra -se significativamente associado quer à síndroma ventilatória restritiva quer à diminuição da transferência alveolocapilar (21,1% vs 6,6%), RR=2,46, IC=[1,35;4,48], p=0,01 e (18,1% vs 3,8%), RR=1,87, pc=0,05, respectivamente. Por sua vez, o genótipo A/A (high) do TNF -á apresentou uma frequência aumentada (p=0,04) nos doentes com eritema nodoso. Conclusões: Os resultados obtidos adicionam evidência ao facto de, quer a classe I quer a classe II do sistema HLA influenciarem a susceptibilidade, o tipo de apresentação, o grau de gravidade e a evolução na sarcoidose. Por outro lado, o eritema nodoso parece relacionar -se com o genótipo de elevada produção de TNF -á, associação esta já anteriormente descrita.Introduction: Several factors suggest a genetic predisposition to sarcoidosis, namely the recognition of race as a risk factor and the occurrence of familial clustering of cases. Several studies have reported an association of sarcoidosis and HLA class I and especially class II alleles in different populations. Aim: HLA class I, class II and TNF-á genotyping in a group of sarcoidosis patients and its relation with clinical presentation and outcome. Material and methods: A total of 104 sarcoidosis patients were included. Clinical presentation, functional, radiology, BAL findings and organ involvement were studied. HLA- A*, -B*, -C*, DRB1*, DQB1* and TNF-á were genotyped by molecular biology methods. DNA was extracted from peripheral blood and PCR-SSP and PCR-reverse hybridisation methods were used. Allele frequencies were compared with controls from the same region. The X2 test was used for discrete values and the Kruskal-Wallis test for continuous values. Results: When patients were compared with controls we noticed increased frequencies of B*08 (10.6% vs. 6.1%), O.R.=1.8, C.I.=[1.1;3.1], p=0.02; DRB1*12 (4.3% vs. 1.7%), O.R.=2.63, C.I.=[1.1;6.1], p=0.03. Patients with erythema nodosum have increased frequencies of the alleles DRB1*03 (28% vs. 9.3%), R.R.=2.39, C.I.=[1.5;3.8], pc=0.01 and DQB1*02 (38% vs. 18%), R.R.=2.1, C.I.=[1.3;3.3], pc=0.02. Allele DQB1*03 is decreased in patients with obstructive pattern R.R.=0.53, C.I.=[0.3;0.9], pc=0.05. Allele DRB1*15 is related to restrictive pattern and reduced diffusion capacity (21.1% vs. 6.6%), R.R.=2.46, C.I.=[1.35;4.48], p=0.01 and (18.1% vs. 3.8%), R.R.=1.87, pc= 0.05 respectively. The TNF-á A/A (high) genotype is significantly associated with erythema nodosum (p=0.04). Conclusions: These data add support to the genetic association of HLA class I and II with sarcoidosis in terms of susceptibility, type of presentation, severity and outcome. Moreover as previously described in other populations, the TNF-á A/A (high) genotype has a significant association with erythema nodosum.

A sarcoidose é doença granulomatosa multissistêmica que geralmente compromete o trato respiratório e os linfonodos hilares. A pele é comumente afetada, mas raramente o couro cabeludo. Dois casos de sarcoidose com lesões no couro cabeludo são relatados: o primeiro, em paciente negra apresentando áreas de alopecia no couro cabeludo associada a outras lesões cutâneas; e o segundo, em paciente branca, portadora de sarcoidose pulmonar, com alopecia como manifestação cutânea isolada. A sarcoidose de couro cabeludo merece especial atenção, pois nos pacientes com essa forma de lesão cutânea existe alta incidência de acometimento sistêmico.Sarcoidosis is a multi-system granulomatous disease that generally affects the respiratory tract and hilar lymph nodes. The skin is also commonly involved, although cutaneous sarcoidosis on the scalp is rare. Two cases of scalp sarcoidosis are reported: the first presented with patchy alopecia, cutaneous sarcoidosis and also systemic disease in a black patient; the second case is related to an uncommon presentation with alopecia as the single cutaneous manifestation in a Caucasian patient with pulmonary sarcoidosis. Scalp sarcoidosis deserves special attention because there is a high incidence of other systemic lesions with this cutaneous manifestation, thus a careful investigation should be performed in these patients.

Apresentação de um caso de febre de origem obscura numa paciente feminina de 35 anos, com queda do estado geral, adenomegalia cervical posterior, monilíase oral, parotidite e irite.Após o parecer oftalmológico, o tratamento foi iniciado e posteriormente com o resultado do exame histopatológico de um linfonodo, diagnosticou-se a Doença de Kikuchi e Fujimoto. Sugerimos que a uveíte anterior seja reconhecida como mais um sinal de suspeita desta doença. São comentados os achados oculares, os aspectos histopatológicos e o tratamento da Doença de Kikuchi e Fujimoto.Report of a case on Kikuchi and Fujimoto's Disease in a young lady who developed a long standing spiking fever, weight loss, cervical adenomegalia, oral moniliasis, parotiditis and iritis.The histopathological findings, course and treatment as well as the importance of a multidisciplinar approach are commented.

A sarcoidose é uma doença granulomatosa multissistémica de etiologia desconhecida, caracterizada histologicamente pela presença de granulomas não caseosos nos órgãos envolvidos. Trata-se de uma doença que pode envolver praticamente qualquer órgão, manifestando-se de múltiplas formas e apresentando-se a várias especialidades clínicas. O envolvimento extratorácico isolado é raro (10%), surgindo mais frequentemente associado ao envolvimento pulmonar ou dos gânglios linfáticos mediastínicos. A nível extratorácico pode ocorrer, entre outros, envolvimento do fígado (50-80%), baço (40-80%), olho (20-50%), nódulos linfáticos periféricos (30%), pele (25%), sistema nervoso (10%), coração (5%), rim e aparelho músculo-esquelético, nem sempre cursando com sintomatologia. A presença de envolvimento extratorácico afecta muitas vezes o prognóstico e a atitude terapêutica da sarcoidose. Os autores fazem uma revisão das principais manifestações extratorácicas da sarcoidose, abordando as suas manifestações clínicas, diagnóstico, tratamento, seguimento e prognóstico.Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology, characterized by the presence of non-caseating epithelioid cell granulomas on tissue biopsy of affected organs. It may involve any organ, presenting in multiple forms to clinicians of different specialities. In its extra-thoracic form it may involve the liver (50-80%), spleen (40-80%), eye (20-50%), extrathoracic lymph nodes (30%), skin (25%), nervous system (10%), heart (5%), kidney, muscle and bone, sometimes without symptoms. The presence of extrathoracic disease may affect the prognosis and treatment options for sarcoidosis. The authors present a review of the major extra-thoracic manifestations of sarcoidosis regarding its clinical presentation, diagnosis, treatment, follow-up and prognosis.

A propósito de um caso clínico, os autores fazem uma breve revisão sobre sarcoidose e o seu potencial envolvimento endobrônquico.In reference to a clinical report, the authors make a review on sarcoidosis and it’s endobronchial involvement.

A sarcoidose é doença granulomatosa não infecciosa de etiologia desconhecida, de cuja patogênese parecem participar os fatores genéticos, imunológicos, ambientais e infecciosos. Vários órgãos podem ser afetados, causando amplo espectro de manifestações clínicas. A pele é acometida em cerca de 20 a 35% dos casos, proporcionando ao dermatologista importante papel no diagnóstico da doença. Epidemiologia, imunologia e tratamento também são discutidos para prover melhor entendimento dessa enfermidade.Sarcoidosis is a noninfectious granulomatous disease of unknown etiology, in which genetic, immunological, environmental and infectious factors seem to participate in the pathogenesis. Any organ or system can be affected with a wide range of clinical manifestations. As involvement of the skin occurs in approximately 20 to 35% of the cases, the dermatologist may play an important role in the diagnosis of the disease. Epidemiology, immunology and treatment are also discussed to provide a better understanding of this entity.

Paciente masculino, 27 anos, com sintomas respiratórios, linfonodomegalia cervical anterior bilateral e hepatomegalia. Os estudos de imagem evidenciaram linfonodomegalia hilar bilateral e infiltrado pulmonar. O paciente foi submetido a biópsias pulmonar e hepática, que evidenciaram presença de granulomas não caseosos. Também foi submetido à biópsia de linfonodo hilar, que revelou a presença de material amilóide. Os achados clínicos, radiológicos e histopatológicos foram compatíveis com sarcoidose e amiloidose ganglionar. A associação entre sarcoidose e amiloidose é raramente descrita.A 27-year-old male patient presented with respiratory symptoms, bilateral enlargement of the cervical lymph nodes and enlarged liver. In the imaging studies, bilateral enlargement of the hilar nodes was observed, together with pulmonary infiltrate. The patient was submitted to lung and liver biopsies, which revealed noncaseating granulomas. The clinical, radiological and histopathological findings were consistent with sarcoidosis and lymph node amyloidosis. The combination of sarcoidosis and amyloidosis has rarely been reported.

Keywords: Diagnosis, Differential; Sarcoidosis; Skin Diseases.

Sarcoidosis is an inflammatory multisystemic disease of unknown etiology, which is characterized by the formation of noncaseating granulomas in the organs involved, mainly lungs and intrathoracic lymph nodes. Skin involvement occurs in 25-35%; it is usually an early finding and it is an accessible and safe location for histopathological study. Cutaneous lesions may present with a variety of morphologies, including papules, nodules, plaques, and infiltrated scars. The diagnosis of sarcoidosis is supported by the recognition of compatible clinical, imagiological and histopathologic features, and the exclusion of other granulomatous disorders. Early diagnosis and systemic treatment could prevent future complications. [ABSTRACT FROM AUTHOR]

Os autores descrevem o caso de uma paciente com esclerose sistêmica (ES) - forma limitada - com comprometimento pulmonar tipo fibrose intersticial. Após sete anos sem acompanhamento, foram identificados gânglios mediastinais e esplenomegalia. A biópsia de linfonodos mostrou granuloma não caseoso sugestivo de sarcoidose. Estamos mostrando, neste caso, a associação de ES e sarcoidose, para chamar a atenção para esse fato e enfatizar que a sarcoidose deve ser lembrada no diagnóstico diferencial das complicações pulmonares da esclerodermia.The authors describe the case of a patient with limited scleroderma and interstitial lung disease. Follow-up was lost for seven years, when patient returned presenting nodular mediastinal enlargement and splenomegaly. Lymph node biopsy showed granulomatous lesions without caseum suggestive of sarcoidosis. This case is being presented to remind the association of scleroderma and sarcoidosis as a possible differential diagnosis of scleroderma pulmonary complications.

Sarcoidose é uma doença granulomatosa sistêmica de ocorrência rara em crianças. Vasculite associada à sarcoidose é incomum e pode acometer vasos de pequeno a grande calibres. Envolvimento sintomático do sistema nervoso central e periférico ocorre em 5% a 10% dos pacientes e acometimento ósseo em 3% a 13%. Sarcoidose do trato geniturinário é extremamente rara. Descrevemos o caso de uma criança de 12 anos com diagnóstico de sarcoidose associada à vasculite, acometimento do sistema nervoso central, ósseo e genital. O amplo espectro de manifestações clínicas raras neste caso ilustra o caráter multissistêmico e multifacetário da sarcoidose.Sarcoidosis is a systemic granulomatous disease with rare occurrence in children. Vasculitis associated to sarcoidosis is uncommon and can affect small, medium or large-sized vessels. Symptomatic involvement of the central nervous and peripheral system occurs in 5% to 10% of the patients and osseous in 3% to 13%. Sarcoidosis of the genitourinary tract is extremely rare. We describe a case of a 12-year-old child with a diagnosis of sarcoidosis associated with vasculitis and with involvement of the central nervous system, osseous and genital. This case illustrates the wide spectrum of rare clinical manifestations in sarcoidosis.

OBJETIVO: Este estudo de casos do Rio Grande do Sul, Brasil, propõe-se a traçar um perfil local da sarcoidose, descrevendo as características dos pacientes, apresentação clínica, função pulmonar, achados radiológicos, histopatológicos e exames bioquímicos de uma série de casos, por ocasião do diagnóstico. MÉTODOS: Estudo retrospectivo de 92 pacientes com sarcoidose, atendidos no Pavilhão Pereira Filho, da Santa Casa de Porto Alegre (RS), entre 1990 e 2003. O protocolo incluiu dados clínicos, bioquímicos, radiológicos, espirométricos e de biópsia. RESULTADOS: Não houve diferença de freqüência entre homens e mulheres (42% e 58%, respectivamente). A média de idade foi de 41,8 ± 14,1 anos, situando-se 87% dos pacientes entre 20 e 60 anos. Houve predomínio em caucasianos (84%). Dados sobre tabagismo mostraram que 61% dos pacientes nunca fumaram, 29% eram ex-fumantes, e 10% ainda fumavam. O diagnóstico foi feito principalmente no inverno (33%). Dentre os dados clínicos destacaram-se: 12% eram assintomáticos, 18% tinham somente sintomas torácicos, 22% somente manifestações extratorácicas, e 48% apresentaram combinação de sintomas torácicos e extratorácicos. A espirometria foi realizada em 79% dos pacientes, no momento do diagnóstico, com resultados anormais em 45% deles, com os seguintes padrões: restritivo em 23%, obstrutivo em 18%, e misto em 4% deles. A distribuição dos tipos radiológicos mostrou 30% tipo I, 48% tipo II e 22% tipo III. CONCLUSÃO: Os achados desta série mostraram-se semelhantes aos descritos na literatura, particularmente na européia.OBJECTIVE: This case study, conducted in the state of Rio Grande do Sul (RS), Brazil, aims to determine the local profile of sarcoidosis, describing patient characteristics, clinical presentation and pulmonary function, as well as analyzing the results of radiological, histopathological and biochemical tests, at the time of diagnosis in a series of sarcoidosis patients. METHODS: A retrospective study of 92 patients with sarcoidosis treated on the Pavilhão Pereira Filho (Pereira Filho [Respiratory Diseases] Ward) of the Hospital Santa Casa, in the city of Porto Alegre, RS, between 1990 and 2003. The protocol included the collection of clinical, biochemical, radiological, spirometric and histological data. RESULTS: There was no significant gender-based difference in frequency (men, 42%; women, 58%). Mean age was 41.8 ± 14.1 years, with 87% of patients being between 20 and 60 years old. Caucasians predominated (84%). Most patients (61%) had never smoked, 29% were former smokers, and 10% were current smokers. The majority (33%) of the diagnoses were made in winter. Among the clinical findings, it is of note that 12% were asymptomatic, 18% presented pulmonary symptoms only, 22% presented extrapulmonary symptoms only, and 48% presented pulmonary and extrapulmonary symptoms. Spirometry was performed in 79% of patients at the time of diagnosis. In 45% of those patients, abnormal results were obtained: a restrictive pattern was seen in 23%, an obstructive pattern in 18% and a mixed pattern in 4%. Classification by radiological type revealed that 30% were stage I, 48% were stage II, and 22% were stage III. CONCLUSION: The findings of this study are quite similar to those of other studies in the literature, particularly those conducted in Europe.

A sarcoidose é uma doença sistêmica de causa indeterminada, caracterizada por granulomas não-caseosos. Embora possa afetar qualquer órgão, esta doença tem sua morbi-mortalidade relacionada principalmente ao acometimento pulmonar, presente em 80% a 90% dos pacientes. Este artigo ilustra as principais manifestações pulmonares da sarcoidose na tomografia computadorizada de alta resolução, incluindo as formas típicas e atípicas.Sarcoidosis is a systemic disease of unknown etiology, characterized by noncaseating granulomas. Although it may affect any organ, morbidity and mortality are most commonly related to pulmonary involvement, which is found in 80-90% of patients. This study illustrates the principal manifestations of sarcoidosis seen in high-resolution computed tomography scans, including typical as well as atypical forms.

Os autores relatam o caso de um paciente de 20 anos, o qual apresentou súbita infiltração em cicatrizes preexistentes na fronte, decorrentes de um acidente há quatro anos. O exame histológico mostrou granulomas não caseificantes, não confluentes, com pobre infiltrado linfocitário. As colorações para fungos e micobactérias foram negativas, assim como o exame com luz polarizada. O estudo radiológico do tórax, exame oftalmológico e a calcemia foram normais, levando ao diagnóstico de sarcoidose em cicatriz sem acometimento extracutâneo. As lesões responderam bem à terapia com corticóide intralesional.The authors report the case of a 20-year-old male patient, who presented sudden infiltration of previous scars on the forehead, which were due to an accident occured four years ago. Light microscopy showed noncaseating, nonconfluent granulomas with few lymphocytes; special stains for fungi and mycobacteria were negative, as well as examination under polarized light. Radiologic examination of the chest, ophthalmologic screening and calcemia were normal, which lead to the diagnosis of a sarcoidosis in previous scars without systemic involvement. There was a good response to treatment with intralesional steroids.

A sarcoidose é uma doença inflamatória sistêmica, de etiologia desconhecida, em que granulomas não caseosos são encontrados nos órgãos acometidos. O envolvimento cutâneo ocorre em 25% dos casos, com grande polimorfismo lesional. O acometimento de cicatrizes é incomum, porém clinicamente característico de sarcoidose cutânea. A maioria dos pacientes com sarcoidose cicatricial tem doença sistêmica. Relata-se o caso de uma paciente de 65 anos, que apresentou nodulações sobre cicatrizes 20 anos, após a realização de procedimentos cirúrgicos, sem manifestações sistêmicas. Salienta-se a importância de se investigar sarcoidose em cicatrizes prévias, com alterações inflamatórias.Sarcoidosis is a systemic inflammatory disorder of unknown origin, in which non-caseating granulomas (small inflammatory nodules) are found in the affected organs. Cutaneous involvement occurs in 25% of cases with a wide range of clinical presentation. The onset of scars is unsual although clinically characteristic of cutaneous sarcoidosis. Most patients with scar sarcoidosis have a systemic disease. It is reported the case of a 65 year-old woman that developed scar nodules 20 years after she had had surgical procedures without systemic manifestations. It is worth mentioning the importance of investigating sarcoidosis with inflammatory alterations in praevia scars.