Pulmonary sarcoidosis associated with psoriasis vulgaris: coincidental occurrence or causal association? Case report

Abstract

Background: Sarcoidosis is rarely associated with a distinct disease. One disease infrequently associated with sarcoidosis is psoriasis.

Case presentation: This case study describes a 38-year-old male, who presented with chest pain, high-grade fever, arthralgias and a skin rash accompanied by bilateral hilar lymphadenopathy on his chest radiograph. Extensive investigations including fiber-optic bronchoscopy with bronchoalveolar lavage and labial and skin biopsies, demonstrated that two distinct clinical entities co-existed in the same patient: pulmonary sarcoidosis and psoriasis vulgaris. Combination therapy for both diseases was applied and the patient was greatly improved.

Conclusion: This is the first well-documented case of sarcoidosis and psoriasis in the same patient, reported on the basis of safe and widely-used techniques that were not available until fairly recently. These disorders might share common pathogenic mechanisms that could explain their co-existence in the patient.

Figure 1

Scaly erythematous plaques of the lower extremity (psoriasis vulgaris).

Figure 2

A labial biopsy reveals lobules of small salivary glands and a small, non-necrotic, sarcoid type epithelioid granuloma (arrow). (Haematoxylin & Eosin, original magnification ×100).

Figure 3

A skin biopsy reveals acanthosis of epidermis, with elongated rete ridges, thin suprapapillary epidermal plates, absent granular layer and hyperkeratosis. A Munro microabscess (arrow) is also noticed within the parakeratotic cornified layer. (Haematoxylin & Eosin, original magnification ×100).