Abstract
An 85-year-old woman developed pigmentation and large subcutaneous indurations on her lower legs. Six months later she was diagnosed with pulmonary tuberculosis. With the administration of anti-tuberculosis drugs, the subcutaneous indurations on her legs did not change, and ulcers developed and enlarged gradually. A microscopic examination of the subcutaneous induration showed diffuse epithelioid cell granulomas in the dermis to the adipose tissue. The vessel walls of the deep dermis were occupied by the epithelioid cell granulomas. It was necessary to distinguish sarcoidosis from erythema induratum Bazin. However, the patient was diagnosed with sarcoidosis complicated by pulmonary tuberculosis because the bilateral hilar lymphadenopathy, uveitis, and elevated angiotensin-converting enzyme (ACE) activity indicated the diagnosis of sarcoidosis complicated by pulmonary tuberculosis. On the basis of these findings, we diagnosed the patient as having sarcoidosis with pulmonary tuberculosis. The patient was treated by oral prednisolone 0.5 mg/kg/day for leg ulcers, and about two and a half months later, they epithelialized. We suggest that ulcerative skin sarcoidosis is a rare but distinctive form of skin sarcoidosis with granulomatous vasculitis. Ulceration is a rare manifestation of sarcoidosis. We present a case of ulcerative sarcoidosis with granulomatous vasculitis that is an even rarer occurrence. We believe that the ulcers were caused by granulomatous vasculitis in this case.
