A rare manifestation of systemic sarcoidosis with livedo reticularis–like eruption in a pediatric patient: A case report

Abstract

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. It can affect all age groups, but it is relatively rare in children.1 Clinical manifestations can vary substantially depending on multiple factors, such as the patient's age and the different organs involved. Infants and children younger than 4 years of age usually present with the triad of cutaneous eruption, uveitis, and arthritis, without classic pulmonary disease.1, 2 Cutaneous sarcoidosis is rare and can manifest with different clinical presentations but rarely with livedo reticularis–like eruption.3, 4, 5 However, older children have a classic presentation resembling that of adults, which includes involvement of the lungs and lymph nodes predominantly.6 It can also be accompanied by generalized constitutional symptoms, such as fever, fatigue, malaise, and weight loss. The diagnosis of sarcoidosis is mainly established by confirming a typical noncaseating granuloma on a tissue biopsy specimen and excluding other granulomatous diseases clinically, microbiologically, and histologically. Other causes of granulomatous disease include infections, such as tuberculosis, autoimmune diseases (eg, Sjogren syndrome and Behcet disease), neoplasms (eg, lymphoma), and other diseases.7, 8, 9 There is no significant difference between childhood sarcoidosis and the adult type, although most children have a better prognosis.1 We describe a unique clinical variant of cutaneous sarcoidosis manifesting as livedo reticularis–like eruption in a pediatric patient with a history of intermittent joint pain, cranial nerve involvement, and uveitis for 1 year.