Woman With Painful Swelling in Fingers

Article Outline

• Diagnosis
  • Cutaneous granuloma of sarcoidosis
• Copyright

[Ann Emerg Med. 2011;57:434.]

A 61-year-old woman with a history of sarcoidosis presented to the emergency department with a 3-month history of painful swelling in her fingers. Hand examination revealed a 3-cm-diameter spherical mass centered in the region of the dorsal distal interphalangeal joint of her left index finger (Figure). There was gross soft tissue breakdown, and 2 similar but smaller growths without breakdown were present on the left thumb and middle fingers.

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• Figure. 

  Painful finger swelling

Used with permission of Joseph P. Habboushe, MD, MBA, Department of Emergency Medicine, New York Hospital Q\ueens of Cornell University, Flushing, NY.

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Diagnosis 

Cutaneous granuloma of sarcoidosis 

Due to interference with her daily activities, the patient opted for partial index finger amputation proximal to the lesion. Surgical pathology confirmed the lesion to be a non-necrotizing granuloma with negative acid-fast bacillus and fungal stain results, consistent with granulomata of sarcoidosis.