LAUSR

tests resulted negative. Chest X-ray, angiotensin-converting enzyme (ACE) levels and routine blood tests were unremarkable. In light of the clinicopathological picture and test results, a diagnosis of cutaneous sarcoidosis was made. We add to the literature our experience with a further case of sarcoidosis presenting with perineural granulomas, potentially mimicking leprosy. In contrast to the case presented by Kazi et al, systemic sarcoidosis was excluded by ancillary tests and no neurologic symptoms were present. Our findings align with those of the series published by Munday et al, who indicated that perineural granulomas in cutaneous sarcoidosis primarily involve the head, and usually, such lesions are not associated with neurological symptoms. We would like to emphasize the importance of such reports, as they question the accepted idea that the finding of perineural granulomas necessarily equals a diagnosis of leprosy. We found them very useful to correctly diagnose our own case. The Egyptian origin of our patient inclined us in a certain way to consider a diagnosis of leprosy. Although migration flows brought tropical, “exotic” infectious diseases into developed countries, such that since 2003, all leprosy cases reported in Italy have been imported, it should be recalled that Mycobacterium leprae was first identified in Europe, where leprosaria hosted patients affected by leprosy for many years. For these reasons, it is mandatory for the dermatological community to be familiar with clinical and histopathological features of this disease, searching for signs of M. leprae infection in all suspected cases. Cutaneous sarcoidosis represents a common clinical pitfall that is usually clarified by histopathological examination. Conversely, in this case, it is the histopathological picture that was misleading, and the diagnosis was clarified thanks to the clinico-microbiological correlation. In conclusion, with our letter, we would like to further stress that cutaneous sarcoidosis should always be kept in mind as a differential diagnosis in case of perineural granulomas with negative AFB and PCR tests.