case_images: PMC10789483_01
case_images: Photograph sent by our patient a day before her hospital admission, documenting the bilateral ankle panniculitis, a skin-colored subcutaneous swelling in lateral view of the right foot (a) and both feet (b).
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case_images: FIG1
case_images: Specifically, there was a fat pad anterior to the lateral malleoli, soft tissue non-pitting edema, and the absence of a Stemmer sign (Figure 1).
case_images: Grayscale ultrasound showing hypoechoic subcutaneous tissue (asterisks), decreased echogenicity of the dermis, and increased size and echogenicity of the fatty lobules (triangles) of the subcutaneous tissue.
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case_images: FIG2
case_images: No micro- or macro-vascular changes were observed (Figure 2). 
case_images: A PA chest x-ray revealing the classic pattern of sarcoidosis: 123 sign or Garland's triad. The characteristics of this sign include mediastinal enlargement, usually right paratracheal (1) and bilateral hilar nodes, on the right (2) and left (3), due to lymphadenopathy.. PA, posteroanterior
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case_images: FIG3
case_images: Notably, the patient's chest X-ray film revealed bilateral hilar lymphadenopathy (BHL) (Figure 3).
case_images: Contrast thoracic CT, in coronal (a) and transverse (b) plane, revealing a classic 123 sign with bilateral hilar (2 and 3) and paratracheal (1) lymphadenopathy, with no other abnormalities.. CT, computed tomography
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case_images: FIG4
case_images: Furthermore, a contrast thoracic abdominal computed tomography (CT) revealed a classic "123 sign" with bilateral hilar and paratracheal lymphadenopathy but no other observable abnormality (Figure 4). 
case_images: (a) Microscopic view of a granuloma (G), highlighting immune cells such as macrophages and lymphocytes in distinctive violet hues following Giemsa staining; (b) microscopic view of a granuloma structure within a cell block sample, visualized after hematoxylin and eosin staining, showcasing the distinctive cellular arrangement and morphology of a non-caseating granuloma (G), on a background of lymphocytes (arrows).. Biopsy slides' images were provided to the Pathology Department team at the Portuguese Oncology Institute, Lisbon.
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case_images: FIG5
case_images: Pathological analysis revealed well-formed non-necrotizing granulomas, characterized by epithelioid histiocytes accompanied by lymphocytes (Figure 5).