以多發性皮下結節表現為主的類肉瘤

Sarcoidosis Presenting with Multiple Subcutaneous Nodules

一位三十歲的男性來本院求診，主訴身上發現許多皮下結節。這些結節散佈在兩側眼瞼、軀幹及四肢皮下的位置已有一年。胸部X光及電腦斷層檢查顯示在肺門及支氣管周圍有許多小的淋巴結及肺部浸潤。二次在他院的皮膚切片，病理組織出現肉芽腫（granuloma）。由於這種特殊的皮膚表現，病人被當作肺外結核在治療，但效果不住。病人最後在本院經由皮膚切片以及支氣管切片，病理報告顯示慢性肉芽腫的發炎反應，並且在使用特殊染色之下，並未發現細菌、黴菌、結核菌以及外來物，才確定診斷為類肉瘤病。經過一個月的類固醇治療後，皮膚的結節全部消失。總結，在未來任何病患如有原因不明的多發性皮下結節，其鑑別診斷中，類肉瘤疾病應該列入考慮，且一旦發現有類肉瘤的可能時，不管有無症狀，皆要作全身性的詳細評估。

We report an unusual case of subcutaneous nodular sarcoidosis in a 30- year-old man. The lesions were multiple, involving the eyelids, trunk, and extremities for one year. Chest X -ray and CT demonstrated an enlargement of many lymph nodes in the bilateral hilar region and infiltration in the peribronchial region. The patient was initially treated as extrapulmonary tuberculosis, in another hospital, but the treatment was in vain. After the biopsy of nodules from the skin and lung at VGH-Taipei, which showed chronic granulomatous inflammation and no fungus, bacteria, mycobacterium, or foreign body, using special stains, the final diagnosis was sarcoidosis. With high-dose steroid treatment, the skin lesions disappeared within one month. Sarcoidosis should be considered in the differential diagnosis of patients presenting with multiple subcutaneous nodules.