Upper Lip Nodule as the First Manifestation of Sarcoidosis: A Case Report

Abstract

Introduction: Sarcoidosis is a chronic disorder characterized by the presence of multiple granules, which could affect different systems and tissues. These granules are histologically characterized by non-caseous granulomatous inflammation; however, their etiology is still unknown. Previous reports state that different antigens may be involved. Sarcoidosis has been rarely reported in the Brazilian population. The objective of this study was to report a clinical case of sarcoidosis presenting with oral manifestations as the first sign and symptom. Case Presentation: An 85-year-old, nonsmoking, white woman was referred to the Department of Stomatology of our clinic in 2019, complaining of a persistently growing nodule on the upper lip and in the right arm subcutaneous tissue lasting for three months. Both lesions were painless and non-mobile/cohesive nodules with borrachoid consistency on palpation, well-delimited margins, and overlying normal-colored mucosa/skin. The oral nodule was surgically excised and sent for routine histopathological analysis, revealing granulomatous inflammation, the presence of central lobules of activated macrophages, epithelioid histiocytes, multinucleated Langerhans cells, and a peripheral cuff of mononuclear cells (lymphocytes). There was no evidence of central necrotic areas; however, asteroid bodies (i.e., starry inclusions) were rarely interspersed within multinucleated Langerhans cells. Warthin-Starry, Fite, and PAS special staining did not show any evidence of granulomatous pathogens, which was compatible with non-infectious granulomatosis. Complementary tests revealed hypercalcemia and elevated serum levels of alkaline phosphatase and angiotensin-converting enzyme. Conclusions: Sarcoidosis can manifest itself in several ways, so the diagnostic process needs to be thorough and comprehensive to confirm the disease. In addition, disease progression should be regularly monitored in patients.