Case presentation :
A 2-year-old child had a one year history of polyarthritis and recurrent
rash that was not objectified during consultations. The diagnosis of
juvenile idiopathic arthritis was made. The patient was treated with
nonsteroidal anti-inflammatory drugs and methotrexate. He was
hospitalized after 2 months because of severe arhralgia and functional
impairment. On skin examination, he had flesh-colored, non-itchy, 4 mm
papular lesions on the arms and forearms with micropapular lesions on
the trunk giving a keratosis pilaris-like appearance (figure
1 ). The ophthalmologic examination showed anterior uveitis with Koeppe
and Busacca nodules. The child did not have respiratory symptoms or
lymphadenopathy. The chest x-ray and blood tests were without
abnormalities. A skin biopsy showed non-necrotizing granulomatous
inflammation of the dermis, confirming the diagnosis of sarcoidosis
(figure 2 ). The patient was treated with systemic
corticosteroids with improvement of clinical signs.
Sarcoidosis in children poses a diagnostic challenge, especially before
the age of 5, given the absence of the classic signs of
sarcoidosis.1 It is characterized at an early age by
the triad: uveitis, arthritis and rash. The cutaneous manifestations are
variable: discrete and confluent papules, eczematiform, ichthyosiform
lesions, subcutaneous nodules, symmetrical maculopapular lesions or
erythroderma.2 The rash is characterized by
exacerbations and remissions. It often precedes other signs and can be
discrete and go unnoticed.
Authorship: All authors had access to the data and a role in
writing this manuscript.