Bone sarcoidosis is an uncommon manifestation of the multisystemic disease with skull involvement being rare. We present the case of a 32-year-old female who was referred by her General Practitioner with a left calvarial lesion on a background of previous unilateral 7th nerve palsy and diabetes mellitus. Images demonstrated a left frontoparietal calvarial osteolytic lesion. She underwent resection by the neurosurgical team with histopathological study revealing noncaseating granulomas, consistent with sarcoidosis. Given absence of other systemic features of sarcoidosis, she did not undergo systemic treatment.

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The key complications of allogeneic bone marrow transplantation (BMT) remain graft-versus-host disease (GVHD) and opportunistic infection. We have analyzed the blood stream infections (BSIs) occurring between day -7 and day 100 in a cohort of 184 adult patients undergoing allogeneic BMT in our center. A total of 167 of the 184 patients (91%) had blood cultures collected, and 69 (38%) patients had a confirmed BSI. Enterobacteriaceae, Pseudomonas aeruginosa, Enterococcus spp., and viridans Streptococcus spp. were the most commonly isolated organisms. Gender, conditioning (myeloablative versus reduced intensity), and donor type (sibling versus unrelated) did not differ significantly between those with and without confirmed BSI. Elevated temperature (>38°C) at the time of culture collection was associated with an almost 2-fold increased likelihood of returning a positive blood culture. The absence of a BSI was associated with a significant improvement in overall survival at 2 years, due to a significant reduction in nonrelapse mortality predominantly unrelated to the primary BSI. The presence of a BSI before engraftment was associated with the dysregulation of IL-6 and IL-8. Our findings suggest that BSI early after BMT defines a group of high-risk patients with enhanced cytokine dysregulation and poor transplant outcome.

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