case_images: PMC11763557_01
case_images: Erythematous lesions on the extensor surfaces of the elbows and knees
case_images: cureus-0017-00000077913-i01.jpg
case_images: PMC11763557_01_cureus-0017-00000077913-i01.jpg
case_images: FIG1
case_images: Physical examination revealed slightly scaly erythematous lesions on the extensor surfaces of the elbows and knees (Figure 1), with no other notable abnormalities.
case_images: CT scan revealing multiple mediastinal and bilateral hilar adenopathies, the largest measuring approximately 28 mm
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case_images: PMC11763557_01_cureus-0017-00000077913-i02.jpg
case_images: FIG2
case_images: The scan revealed multiple mediastinal and bilateral hilar adenopathy, with non-calcified nodes and no signs of central necrosis (Figure 2), the largest measuring approximately 28 mm.
case_images: (A) In the EBUS-TBNB of a hilar lymph node, non-necrotizing, well-demarcated epithelioid granulomata surrounded by a lymphocytic infiltrate were observed within fragments of fibrous tissue (HE, 200x). (B) On the skin biopsy, a dermal chronic non-necrotizing granulomatous inflammation is present, predominantly on the superficial dermis (HE, 100x). (C) Skin granulomata showed confluence and comprised some giant multinucleated cells (arrow); a slight lymphocytic infiltrate surrounded the granulomata (HE, 200x). Ziehl-Neelsen and PAS stains were negative for acid-fast bacteria and fungi in both lymph nodes and skin samples (not pictured). EBUS-TBNB: endobronchial ultrasound-guided transbronchial needle aspiration; PAS: Periodic Acid-Schiff
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case_images: FIG3
case_images: Histological examination revealed lymphoid cells and small epithelioid granulomas (Figure 3A). A skin biopsy of the lesions revealed chronic granulomatous inflammation with epithelioid granulomas (Figures 3B-3C), negative AFB staining, and no dysplasia or malignancy.
case_images: Cardiac MRI showing a focal area of late gadolinium enhancement in the mid-wall (non-ischemic pattern) located at the basal segment of the anterior wall
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case_images: FIG4
case_images: T2-weighted images, indicating focal myocardial fibrosis. The inflammatory activity and the other systemic findings were suggestive of myocardial involvement caused by sarcoidosis (Figure 4).