Occupational exposure as a presumable cause of subcutaneous sarcoidosis in a tannery worker – case report and review of the literature

Sarcoidosis is a granulomatous disease with protean manifestations, most commonly involving hilar lymph nodes, pulmonary parenchyma, skin, joint/bones and eyes. The prevalence varies markedly (1–40/100,000) and the peak incidence typically occurs in young and middle aged adults. Females are slightly more commonly affected [1–3].
Skin lesions are polymorphic and seen in about 25% of patients, in some cases being the initial or the sole sign of the disease. They may be specific with the presence of sarcoidal granulomas or non-specific (reactive). Among specific skin lesions subcutaneous nodules are distinctly rare [4, 5].
The cause of the disease remains unclear. Recent epidemiological surveys support the view that some exposures in occupational or environmental settings might be antigens that elicit a specific sarcoid (granulomatous) reaction, including systemic or cutaneous sarcoidosis [2, 3, 6–8].
This report describes a long-term tannery worker who developed subcutaneous masses of the periorbital area that proved to be sarcoidal infiltrations. We also review the literature on this subject to better define the clinical features of this unusual disease subset and potential environmental risk factors.
A 59-year-old Caucasian man was referred to the Dermatological Department due to subcutaneous firm, non-tender infiltration and oedema of the left buccal area and upper eyelid with significant narrowing of the left palpebral fissure that started 2 years earlier (Figure 1 A). The overlying skin was erythematous and non-ulcerated. The patient had been working for many years at tanning hides, had proven chrome contact allergy and otherwise no significant medical history. On ophthalmic examination no pathological changes within the left eye were detected and visual acuity was normal (V.o.u. – visus oculi utriusque, visual acuity of both eyes = 1). There were no eyeball motility disturbances, and intraocular pressure was normal (13 mm Hg). Magnetic resonance imaging (MRI) of the orbits performed on a 1.5-T scanner revealed nonspecific thickening and prominent homogeneous enhancement of the left upper eyelid, conjunctiva and anterior part of sclera. Intraocular muscles and optic nerves were not affected with homogeneous signal intensity (Figure 2 A). A lesional biopsy revealed chronic inflammation with the presence of non-caseating granulomas within the dermis and subcutaneous tissue, consistent with sarcoidosis (Figure 2 B). Special stains...


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