Abstract

We report a case of a 75-year-old South Asian male with a prior history of extrapulmonary tuberculosis with intracranial involvement and new painful, pruritic, firm, annular, crusted pink plaques on his left posterior shoulder and chest. The patient had undergone over one year of anti-mycobacterium tuberculosis therapy, with completion of therapy within weeks of onset of his new cutaneous findings. Skin tissue cultures and mycobacterium PCR studies were negative for organisms. Four-millimeter punch biopsy and histopathologic analysis of the patient’s new skin lesions demonstrated non-caseating granulomas consistent with a diagnosis of sarcoidosis. The patient’s cutaneous sarcoidosis underwent spontaneous resolution within three months, and he re-established care with pulmonology and ophthalmology. There is strong histological and basic science evidence to suggest a link between tuberculosis and sarcoidosis as both conditions involve granulomatous inflammation, and studies have demonstrated an increased likelihood of identifying mycobacteria or mycobacterial tissue antigens in sarcoidosis tissue. However, only a handful of clinical cases of sarcoidosis have been reported following tuberculosis, with our patient highlighting a novel case of cutaneous sarcoidosis following intracranial tuberculosis. Dermatopathologists should be aware of not only the histopathologic findings of sarcoidosis, but the relationship between tuberculosis and sarcoidosis to facilitate early diagnosis, treatment, and subsequent routine surveillance of this condition.

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