Name: AD Age: 42 Gender: Female Location: Urban area in Nigeria Occupation: Teacher Medical History: No significant past medical history

AD, a 42-year-old female teacher, presents to the local hospital with complaints of joint pain and swelling, as well as facial skin lesions over the past four months.

AD initially noticed pain and swelling in her ankles and wrists, which progressively worsened. She also developed erythematous, painless skin lesions on her cheeks and nose, known as lupus pernio. She denies fever, cough, shortness of breath, or significant weight loss. Her symptoms have affected her ability to perform daily activities and work.

AD lives in a densely populated urban area with her husband and three children. She does not smoke and has no known exposure to occupational hazards. Access to healthcare is relatively good in her urban setting, although specialized care for rare conditions like sarcoidosis can be limited.

- General: Appears fatigued but in no acute distress - Vitals: BP 130/80 mmHg, HR 75 bpm, RR 18 breaths/min, SpO2 98% on room air, temperature 37.0°C - Musculoskeletal: Tender, swollen joints in ankles and wrists - Dermatological: Raised, erythematous plaques on the cheeks and nose (lupus pernio) - Other Systems: No significant findings

-Chest X-ray: Normal findings, no evidence of pulmonary involvement - Skin Biopsy: Non-caseating granulomas consistent with sarcoidosis in skin lesions - Blood Tests: Normal complete blood count (CBC), elevated angiotensin-converting enzyme (ACE) levels

Extrapulmonary Sarcoidosis (predominantly cutaneous and musculoskeletal involvement)

1. Symptomatic Treatment: - Nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain and swelling. - Topical corticosteroids and moisturizers for skin lesions. 2. Systemic Treatment: Consideration of corticosteroids (e.g., prednisone) for moderate to severe symptoms not responsive to NSAIDs. 3. Regular Monitoring: Follow-up appointments to assess response to treatment and monitor for potential progression or complications. 4. Patient Education: Counselling on the chronic nature of sarcoidosis, adherence to treatment, and lifestyle modifications. 5. Referral: Consideration for referral to a rheumatologist or dermatologist for specialized care and management.

The prognosis for extrapulmonary sarcoidosis varies widely, with many patients experiencing remission or stabilization of symptoms with appropriate treatment. Regular monitoring and follow-up are essential to manage the disease effectively. This case highlights the challenges and management considerations for a patient with extrapulmonary sarcoidosis in an urban setting in sub-Saharan Africa, focusing on cutaneous and musculoskeletal manifestations.