A young lady presented with bilateral nodular lesions on shins. She was also found to have bilateral hilar lymphadenopathy on chest X-ray. Mantoux test reveals indurations of 5 mms. Skin biopsy would reveal -

Ans. is 'a' i.e., Non caseating granulomas o Skin lesions in this patient in Erythema nodosum. o Erythema nodosum, bilateral hilar lymphadenopathy negative mantoux test in strongly suggestive of sarcoidosis. Skin biopsy (or biopsy from hilar nodes, conjunctiva, lip, or spleen, intraabdominal nodes) would reveal non-caseating granulomas. Signs and symptoms of sarcoidosis Any organ system of the body can be involved. However lungs with lymph nodes, skin and eye are the three most common sites involved in sarcoidosis. 1. Lungs with lymph nodes (95%) o Respiratory complaints including cough and dysnea are the most common presenting symptoms. o Usually the infiltrate in sarcoidosis are predominantly an upper lobe process. o There is bilateral hilar lymphadenopathy. 11. Skin (24%-43%) o Erythma nodosum o Maculopapular lesions o Hyper-or hypopigmentation o Keloid formation and subcutaneous nodules o Lupus pernio --> Involvement of the bridge of the nose, the area beneath the eyes and check. It is diagnostic for a chronic form of sarcoidosis. o Lofgren's syndrome --> Erythma nodosum with hilar adenopathy and uveitis. HI. Eye (12-29%) o Uveitis o Retinitis Cause Photophobia, blurred vision, increased tearing o Pars planitis IV. Non-specific constitutional symptoms are fatigue (most common), fever, night sweat and weight loss. Other organs/systems involved are o Liver o Parotid glands o Hea Spleen o Brain (Neurosarcoidosis) o Endocrine --> Granuloma can secret 1-25 (OH)2 Vit D which causes hypercalcemia. Uveoparotid fever ---> Uveitis + parotitis + VII nerve palsy, it is associated with Heerfordt - waldenstrom syndrome.