Three patients developed subcutaneous sarcoidosis in their arm after receiving an injection, but symptoms disappeared after treatment with minocycline, a broad-spectrum antibiotic, according to a research report.
James Abbott and colleagues at the University of Pennsylvania School of Medicine wrote the report, “Isolated Subcutaneous Sarcoid-Like Granulomatous Inflammation Occurring At Injection Sites: 3 Patients Treated Successfully With Minocycline.” It was published in the journal JAAD Case Reports.
Sarcoidosis is characterized by an accumulation of immune system cells, or granulomas. It can occur in multiple organs, impairing their function. Symptoms are usually nonspecific, including fever, fatigue, and weight loss, but they can vary depending on the organs that are affected.
All three patients developed sarcoidal granulomas at the site in their arm where they received allergy shots and leuprolin acetate, which eases cancer symptoms. None of the three had had sarcoidosis or other lesions.
Subcutaneous sarcoidosis — whose name refers to the disease starting below the skin — is a rare manifestation of sarcoidosis. But previous reports of similar cases have suggested that it may mark the development of a mild form of systemic sarcoidosis.
“Subcutaneous nodules are rare cutaneous manifestations of sarcoidosis occurring in up to 6% of cases, frequently manifesting on the forearms as indurated linear bands, although lesions can occur at any site,” the researchers wrote. “In our patients, lesions developed on the bilateral posterior arms, which correspond to prior [injection] sites and differ from the common locations of subcutaneous sarcoidosis.”
Researchers believe granulomas can develop in genetically susceptible individuals as an over-reaction to a stimuli, in this case an injection.
Treatments for subcutaneous sarcoidosis include corticosteroids and immunosuppressive agents. The three patients were treated with minocycline as a first-line therapy. They all showed a complete response to treatment, similar to what had been reported in other patients with the same condition.
“These patients’ lesions represent an entity that is clinically and histologically compatible with subcutaneous sarcoidosis and, as such, require the same evaluation, including assessment for systemic disease and management,” the researchers concluded. “Whether these patients are ultimately thought to have isolated single-organ subcutaneous sarcoidosis, or subcutaneous sarcoid-like granulomas, depends on the evolving definition of sarcoidosis and acceptance of a single-organ sarcoid variant.”