Systemic sarcoidosis presenting as facial palsy, granulomatous tattoo reaction and sarcoidal scar.

Cutaneous lesions are observed in approximately 25% of patients with systemic sarcoidosis. Scar sarcoidosis is a rare but peculiar cutaneous form of sarcoidosis associated with trauma, surgery, tattoos and other types of damage. We present a 32-year-old male patient with a history of unilateral facial nerve palsy, nephrolithiasis and lung involvement. A chest CT revealed multiple bilateral hilar and mediastinal lymphadenopathy and PET-CT demonstrated an inflammatory response in multiple organs and regions. Recently, the patient had developed asymptomatic papulo-nodules scattered within the areas of tattoos and previous trauma. Histopathological examination of nodules from those different areas supported the diagnosis of sarcoidosis. The lesions almost cleared after systemic therapy with oral prednisone. It is worth remembering that skin lesions in areas of tattoos and trauma may be prominent symptoms of systemic sarcoidosis. Patients with systemic sarcoidosis should avoid tattooing.