Endgames Picture Quiz

An odd eruption

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c6845 (Published 26 January 2011) Cite this as: BMJ 2011;342:c6845
  1. A Abdul-Wahab, specialist registrar,
  2. P Banerjee, consultant dermatologist
  1. 1Department of Dermatology, University Hospital Lewisham, London, UK
  1. Correspondence to: A Abdul-Wahab alyawahab{at}gmail.com

A 55 year old African-Caribbean man presented to the dermatology department with a two month history of asymptomatic pink, hyperpigmented, and hypopigmented nodules and plaques on his neck, face, and chest. These developed after a brief inpatient admission to a medical ward with shortness of breath and cough, for which he was given antibiotics for presumed community acquired pneumonia. A chest radiograph showed bilateral pulmonary infiltrates, and his symptoms improved following seven days of intravenous co-amoxiclav and erythromycin. He otherwise had no relevant medical or family history.

Questions

  • 1 What is the probable diagnosis?

  • 2 Which investigations should be performed?

  • 3 How should this condition be managed?

Answers

1 What is the probable diagnosis?

Short answer

The most likely diagnosis is cutaneous sarcoidosis.

Long answer

The images show multiple erythematous, hyperpigmented, and hypopigmented nodules, papules, and plaques on the posterior and anterior neck. There are no surface changes, and the overlying surface appears smooth. The nodules appear to be dermal in origin, rather than epidermal, and we know from the history that they are painless. The eruption of dermal nodules in an African-Caribbean patient with respiratory symptoms should alert the physician to a strong possibility of sarcoidosis. Sarcoidosis is known as a “great mimicker.” In this scenario the …

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