A Japanese Case of Vertebral Sarcoidosis

Abstract

We herein report the first Japanese case of vertebral sarcoidosis diagnosed using multiple imaging modalities and a biopsy. CT, MRI and (18)F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) detected multiple vertebral lesions, and a vertebral biopsy guided by the PET findings confirmed the diagnosis of vertebral sarcoidosis. Although the disease was refractory to corticosteroids, treatment with methotrexate (MTX) achieved a good response. Our case suggests that MRI and 18F-FDG PET are useful for determining the site for a biopsy and that MTX is effective for treating vertebral sarcoidosis.

Bone Marrow Sarcoidosis with Pancytopenia and Renal Failure Presenting as Fever of Unknown Origin: The Pivotal Role of 18F-FDG PET/CT in Lesion Detection

“…Furthermore, the fusion of 18F-FDG PET with computed tomography (CT) (18F-FDG PET/CT) has been shown to improve diagnostic accuracy and cancer staging 5 . As reported previously, 18F-FDG PET/CTguided biopsy of soft tissues increases the probability of identification of sarcoidosis as the main cause of FUO [6][7][8] . In this case report, we describe a patient with FUO, pancytopenia, and renal failure, who was incidentally diagnosed with bone marrow sarcoidosis using 18F-FDG PET/CT for diagnosis.…”

“…Although there is a case report on bone marrow sarcoidosis with lung involvement in Japanese patients 8 , this is the first report of bone marrow sarcoidosis with no apparent abnormality in the initial chest X-ray and CT scans. Patients with sarcoidosis may present with nonspecific systemic symptoms such as malaise, lethargy, night sweats, and FUO 2,3,9,10 .…”

Evaluation of sarcoidosis with multiple bone lesions using both bone scintigraphy and FDG-PET/CT: A case report

“…The short tubular bones of the hands and feet are most frequently involved in bone lesions of sarcoidosis and the vertebrae or pelvic bones are rarely involved. Table 2 summarizes previously reported cases of sarcoidosis with vertebral bone lesions, including the present case [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. Among the 16 cases reported, 11 were symptomatic, and the symptom observed in all these cases was pain.…”

Resolution of Osseous Sarcoidosis with Methotrexate

“…Most additional support for specific treatment regimens comes in the form of case series or case reports, the largest of which included 9 cases of symptomatic skeletal disease treated with varying combinations of prednisone, MTX, HCQ, or TNF-alpha inhibitors in refractory cases, with 67% (6/9) of these patients endorsing resolution of symptoms at time of last follow-up. Several additional single case reports have demonstrated clinical and/or radiographic improvement of osseous sarcoid lesions utilizing a variety of treatment approaches most commonly with corticosteroid therapy and/or a disease-modifying antirheumatic drug such as MTX [10–14].…”