Monthly QUIZ 

February 2003


Designed by;

O. Zargari , MD

Razi Hospital, Rasht, Iran


A.H. Ehsani, MD 

was the first correct respondant for this quiz

A 39-year-old woman presented with two-year-history for asymtomatic papular lesions on her face and extremities. Otherwise she was normal. On examination multiple papular and plaque-type lesions were seen on her face and extensor surfaces of her extremities. Routine laboratory examinations were normal. Tuberculin test was also negative. What's your diagnosis?

Dx: Sarcoidosis

Sarcoidosis is a multisystem disease characterized by the prescence of noncaseating granuloma in tissues. Cutaneous involvement is common in sarcoidosis and although the skin manifestations of sarcoidosis are protean, the majority of specific lesions are papules or plaques.Depression of cell-mediated immunity is the hallmark of sarcoidosis and indeed the first immunological defect to be demonstrated was lack of reactivity to tuberculin test.

The protean cutaneous manifestations of sarcoidosis lead to an exhaustive list of differential diagnoses including lichen planus (which is usually pruritic), leishmaniasis   ( which usually ulcerate), leprosy, granuloma annulare, necrobiosis lipoidica and many other dermatose.