Case report
Nail dystrophy and bony involvement in chronic sarcoidosis

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A patient with a chronic course of sarcoidosis with pulmonary and cutaneous involvement presented with dystrophy involving 20 nails. Histologic analysis revealed noncaseating granulomas consistent with nail sarcoidosis, and radiologic evaluation revealed bony cysts typical of sarcoidosis. Nail dystrophy in sarcoidosis is rare; however, when present, it signifies a chronic course of disease. We review the incidence, histopathologic correlation to clinical symptoms, radiologic findings, differential diagnosis, and treatment of nail dystrophy in sarcoidosis.

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Discussion

Cutaneous sarcoidosis occurs in 20% to 35 % of patients with sarcoidosis and often presents with the onset of disease.1 However, nail dystrophy in sarcoidosis occurs less frequently, ranging from 1 in 400 patients2 to 3 in 188,3 meaning it is either uncommon or underreported.

The most common nail plate changes described in sarcoidosis include opacity, fragility, thickening, layering, convexity, longitudinal ridging, pitting, atrophy, and nail loss.2, 4, 5, 6, 7 Splinter hemorrhage4 and red or

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Conflicts of interest: None declared.

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