Two Case Reports on Sarcoidosis: Experience in a Tertiary Centre in South-South Nigeria

Abstract

Sarcoidosis is a multisystem granulomatous disorder of unknown cause, characterised histologically by non-caseating granulomas and variable clinical involvement of the skin, lungs, lymph nodes, eyes, and other organs. Cutaneous manifestations may provide an important diagnostic clue, particularly when systemic symptoms are absent or limited. This case report describes two male patients evaluated at the dermatology outpatient clinic of Rivers State University Teaching Hospital, Port Harcourt, Nigeria, among suspected cases of sarcoidosis seen over a five-year period from January 2021 to December 2025. The first patient was a 45-year-old man with a two-year history of recurrent erythematous papular lesions arising at sites of previous scarification marks on the face, chest, upper arms, and abdomen. The lesions were neither painful nor pruritic. Chest radiography showed stage 0 sarcoidosis; the serum angiotensin-converting enzyme level was elevated at 214.3 IU/L, and skin biopsy demonstrated an atrophic epidermis with numerous naked, non-necrotising granulomas and inflammatory giant cells. Electrocardiography was normal, whereas the erythrocyte sedimentation rate was mildly elevated. A diagnosis of scar sarcoidosis was made, and treatment with topical betamethasone cream twice daily for six weeks led to marked clinical improvement, with no recurrence reported during at least eight months of follow-up. The second patient was a 32-year-old man with a 19-month history of a recurrent, transient, erythematous papular rash. The serum angiotensin-converting enzyme level was elevated at 292.52 IU/L, and chest radiography showed bilateral hilar lymphadenopathy consistent with stage 1 sarcoidosis. Skin biopsy was not performed because active lesions were absent during clinic visits; the patient was referred for pulmonology follow-up. These cases highlight the variable presentation of sarcoidosis and the importance of considering this diagnosis in patients with atypical cutaneous lesions and supportive systemic findings.