RESUMO
An 83-year-old Caucasian male presented with a pruritic erythematous patch to his right inguinal region, which he had contracted five months ago. After months of topical antifungal and steroid therapies, the patient was referred to dermatology due to a lack of lesion improvement. A 5.0 mm punch biopsy with immunohistochemical staining revealed the presence of pleomorphic nuclei with cytoplasm replete with mucin, suggestive of superficial extramammary Paget's disease (EMPD). As he was reluctant to undergo a surgical assessment, the patient underwent consultation and management with 30 sessions of superficial electron beam radiotherapy. A week after the completion of radiation therapy, the patient's skin exhibited minimal erythema with surrounding hyperpigmentation to the affected inguinal skin, suggesting clearance of the disease. This case highlights the importance of an accurate diagnosis in a timely manner as neoplastic cases have a metastatic risk with potentially devastating results.
RESUMO
We herein report a unique case of sarcoidosis in a 44-year-old Caucasian female. The patient was initially evaluated for hematochezia and diagnosed with diverticulitis after computed tomography (CT) scan of the abdomen and pelvis. This imaging also incidentally showed a large mass abutting the esophagus. Further imaging of the mass revealed widespread lymphadenopathy in the thorax without any respiratory or classic B symptoms present. The remaining workup caused concern for possible lung or hematologic malignancy. Following biopsy of a thoracic lymph node, the patient was diagnosed with sarcoidosis. This patient met only one of the usual demographic criteria associated with sarcoidosis and none of the lab criteria. While sarcoidosis is typically a benign disease, this case exemplifies how it may appear as a more sinister entity and warrants extensive workup to rule out malignancy.
