A rare presentation of sarcoidosis, back pain and spondylolisthesis

Abstract

A 48-year old man presented with back pain that was resistant to treatment. An MR scan showed spondylolisthesis at L4-5 and narrowing of the exit foraminae. He had a posterior fusion which did not relieve his symptoms. He continued to have back pain and developed subcutaneous nodules in both forearms. Biopsy from the skin revealed cutaneous sarcoidosis, and one from the lumbar spine showed sarcoidosis granuloma between the bone trabeculae. A CT scan of the abdomen and chest revealed axillary lymphadenopathy, mediastinal enlarged nodes, apical nodular nodes and splenomegaly. The patient was started on large doses of methotrexate and steroids. His angiotensin-converting enzyme and calcium levels returned to normal and the back pain resolved.

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis)

“…That extrapulmonary symptom has been reported in sporadic case reports as a rare symptom or presentation of sarcoidosis (13). Even back pain has been complained frequently, only a few of those patients had pathological findings of sacroiliitis might be related with sarcoidosis (14).…”

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.…”

Sarcoidosis Presenting as a Proximal Phalangeal Bony Swelling—A Case and Review of the Literature

“…Bone biopsy is key to a definitive and early diagnosis [12, 23] because the clinical and radiological features are often nonspecific. It is essential to rule out other potential causes for lytic bone lesion such as primary and secondary bone tumors and nontumorous conditions.…”