瘢痕性结节病国内首报

患者女，54岁。５年前出现全身乏力，双膝关节肿痛，体质量下降。就诊半年前于左眉外侧陈旧瘢痕处出现一硬结。皮疹先后累及躯干和四肢，特别是手部原有陈旧瘢痕处均出现红斑，结节。体检：双腋下淋巴结肿大。左眉外侧一斑块，位于原有瘢痕处。右上臂伸侧可及一皮下肿块，左手瘢痕处和双足底可见多个暗红色结节。左侧前臂及躯干少许散在的红色小丘疹。血清血管紧张素转化酶82 kU/L。CT示两肺散在多发模糊小结节灶，纵隔及腋下多发肿大淋巴结影，双侧肺门淋巴结未肿大。组织病理符合结节病。予甲泼尼龙口服后皮损明显好转。本例皮损同时具有瘢痕、结节、斑块、皮下肿块和丘疹，较为少见。对原有的陈旧性瘢痕出现活动，表现为红肿、结节，是诊断结节病的重要线索。

Scar sarcoidosis: first case report in China

A 54-year-old woman presented with a five-year history of malaise with weight loss and arthralgia of both knee joints. Six months prior to the presentation, an indurated nodule developed at the site of an old scar on the temporal side of left eyebrow. Subsequently, erythema and nodules spread over the trunk and extremities, especially at the sites of old scars on the hands. Physical examination showed bilateral axillary lymphadenectasis, a plaque at the site of an old scar on the temporal side of left eyebrow, a subcutaneous mass at the extensor aspect of the right upper arm, multiple dark-erythematous nodules at the site of scars on the left hand and both soles, few small erythematous papules scattered on the left forearm and trunk. The serum angiotensin converting enzyme concentration was high (82 kU/L). Computer tomography of thorax showed multiple obscure tubercles in both lungs and swollen lymph nodes in mediastina and axillary fossa, but no hilum pulmonis lymphadenectasis was observed. Histopathology revealed non-caseating granulomas with multinucleated giant cells. Neither acid-fast bacilli nor PAS staining was positive. A diagnosis of scar sarcoidosis was established. The lesions obviously improved after one-month treatment with oral methylprednisolone. This case represents a rare subtype of sarcoidosis that arose in old sears and clinically manifests as scar, nodules,plaques, subcutaneous masses and papules. The reactivation of old scars, which manifests as erythematous swelling and nodules, may highly suggest the diagnosis of sarcoidosis.