Detection of Sarcoidosis Based on Subcutaneous Nodules in the Dorsum of the Right Hand

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  • 右手背部の皮下結節を契機に発見されたサルコイドーシスの 1 例
  • 症例 右手背部の皮下結節を契機に発見されたサルコイドーシスの1例
  • ショウレイ ミギテ ハイブ ノ ヒカ ケッセツ オ ケイキ ニ ハッケン サレタ サルコイドーシス ノ 1レイ

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A 58-year-old woman had previously visited another clinic with symptoms of her right hand, which was swollen with itching lasting about 1 month, despite the absence of particular triggers. Although the patient received topical steroid therapy, her symptoms did not improve, leading to a referral to our department. Three elastic hard subcutaneous nodules over 1 cm in diameter were palpated on the dorsum of the right hand. X-ray and computed tomographic images of the dorsum of her right hand showed no marked changes, but magnetic resonance imaging revealed areas of low intensity on T1- and T2-weighted images at the sites of the subcutaneous nodules. A skin tissue examination of a portion of one of the nodules revealed a naked granuloma, and a chest X-ray showed bilateral hilar lymphadenopathy. Moreover, gallium-67 scintigraphy detected abnormal accumulations in the pulmonary hilum, the dorsum of the right hand, and a parotid gland, which led to a diagnosis of subcutaneous sarcoidosis. Oral administration of tranilast 300 mg/day was initiated, and it achieved resolution of the clinical features. In this manner, subcutaneous nodules are often of great diagnostic value for making a diagnosis of sarcoidosis. Especially, MRI imaging was not only a diagnostic aid but could also provide useful information about the number and location of nodules. Interestingly, oral administration of tranilast 300 mg/day could lead to resolution of the clinical features in the present case.

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