# Darier-Roussy Subcutaneous Sarcoidosis Masquerading as Multiple Abscesses: A Report of a Rare Case

## TL;DR

A rare case of Darier-Roussy subcutaneous sarcoidosis was mistaken for multiple abscesses, highlighting the need for accurate diagnosis.

## Contribution

This case report highlights the diagnostic challenge of subcutaneous sarcoidosis mimicking abscesses.

## Key findings

- The patient's lesions were initially misdiagnosed as abscesses due to their appearance and lack of response to antibiotics.
- A biopsy confirmed the diagnosis of sarcoidosis, revealing characteristic granulomatous features.
- Treatment with hydroxychloroquine and prednisone led to improvement in the patient's condition.

## Abstract

Sarcoidosis is an idiopathic multisystemic granulomatous disease that mainly affects the lungs. Darier-Roussy subcutaneous sarcoidosis is among the specific and least encountered skin manifestations of sarcoidosis. In this case study, we report how subcutaneous sarcoidosis could mimic multiple abscesses presentation and hinder reaching a definitive diagnosis. A 65-year-old female presented with five, multiple, deep-seated skin lesions on the forearm, chest, and scalp. The lesions showed redness and tenderness. The patient also experienced arthralgia in the right ankle. Laboratory workup of the patient showed a high erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count. The patient was suspected to have multiple abscesses, which were managed with antibiotics with no response. Thus, a computed tomography (CT) scan of the chest was done and showed mediastinal lymphadenopathy. A biopsy was taken from one of the right forearm skin lesions, and it revealed characteristic features consistent with sarcoidosis. The patient was managed with hydroxychloroquine and a tapering dose of prednisone. Therefore, subcutaneous sarcoidosis should be included in the differential diagnosis of subcutaneous lumps.