Case Number : CASE 4616 - 14 April 2025 Posted By: Admin_Dermpath

Sarcoidal type granulomas with the clinical hx - maybe eruptive cutaneous sarcoidosis?

Those granulomas are not quite nude. I would like to see some acid fast stains to rule out TB (and other mycobacteria). May I suggest cutaneous Crohn's ? (has the patient any history of gastrointestinal issues?)

TB granuloma 

? granuolomatous MF / need s special stains 

On 14/04/2025 at 16:09, msofopoulos said:

Those granulomas are not quite nude. I would like to see some acid fast stains to rule out TB (and other mycobacteria). May I suggest cutaneous Crohn's ? (has the patient any history of gastrointestinal issues?)

I agree.  However, whereas cutaneous Crohn's is in the differential from a pathological point of view, it would be most unusual for Crohn's disease to present in the skin so widely and quickly.

Kissing granulomata. Favor eruptive sarcoidosis.

Will do acid-fast stains and fungal stains.

On 14/04/2025 at 16:03, Jacob said:

Sarcoidal type granulomas with the clinical hx - maybe eruptive cutaneous sarcoidosis?

Agree. 

thanks! great case

It is a case of Borderline (BB) Leprosy. Here is the attached image for Fite stain which is positive for acid fast bacilli. In our practice, we have observed that BB Hansen's can show two types of patterns: one is that of admixed epithelioid and foamy histiocytes with lymphocytes, along neurovascular bundles in a curvilinear pattern typical of leprosy; the other is more diffuse infiltrate predominantly of epithelioid histiocytes without signficant foamy histiocytes or lymphocytes forming sarcoid like granulomas. It is this second pattern which closely resembles sarcoidosis, fortunately AFB is usually positive in such cases, unless pateint has been partially treated, in that case, without AFB, it is difficult to differentiate from sarcoidosis, but clinical does help.