Osseous sarcoidosis: a case series

Abstract

Sarcoidosis is an inflammatory disorder characterized by noncaseating granulomas infiltrating affected organs. Any organ system can be involved, and more than 90 % of patients have a primary pulmonary manifestation. The incidence of radiographically evident bone involvement has been reported over a wide range: from 3 to 39 % depending on the population studied and imaging modalities used. Any bone may be affected in osseous sarcoidosis. Bilateral involvement of the phalanges of the hand and feet is most common. However, reports of long bone, skull, rib and vertebral involvement have appeared. To date, there are no specific tools for the assessment of skeletal disease activity in sarcoidosis. Plain radiograph picks lesions in the small bones of hands and feet greater than does in other bones. Bone scan is useful for defining the extent of the skeletal disease and bone marrow involvement. Magnetic resonance imaging usually demonstrates multifocal lesions within the vertebrae that are hypointense on T1-weighted images and hyperintense on T2-weighted images. In cases of multifocal bone lesions and an established diagnosis of sarcoidosis, a diagnosis of bone sarcoidosis should be considered in the differential diagnosis. Optimal treatment of osseous sarcoidosis remains controversial. We present five cases of multisystem sarcoidosis with skeletal involvement including long bones and vertebrae and a description of immunosuppressive therapies used in our patients. A literature review highlighting the diagnostic approach using radiographic imaging, as well as treatment strategies, is provided.

Bone Lesions, Lymphadenopathy, and Hepatic Granulomas in a Patient With Psoriasis

“…There are only 2 other case reports of extensive vertebral sarcoidosis also presenting with minimal to no bone‐related symptoms . Elevated serum alkaline phosphatase in our patient may have been from liver or bone involvement, although serum alkaline phosphatase level is frequently normal in osseous sarcoidosis .…”

Sarcoidosis with prevalent and severe joint localization: a case report

“…In our case, the patient came to our attention after surgical amputation of his fingers of hands and toes affected by the disease, with a new presentation of the disease on the surgical stumps associated with mediastinal lymphadenopathy. The involvement of the interphalangeal joints in combination with pathology of soft tissue and mediastinal lymph-nodes enhances the suspicion of osteoarticular sarcoidosis, although the lungs and skin appear to be free from injury [14, 15]. Therefore, in order to assess the diagnosis of articular sarcoidosis, other rheumatologic and granulomatous diseases have been excluded, including infections (tuberculosis and others).…”

A Giant Enchondroma Mimicking Sarcoidosis: Report of Case and Review of the Literature

“…In our case, her values of laboratory tests were all within normal limits except erythrocyte sedimentation rate (40mm/h) and C-reactive protein levels (50mg/L). Bone sarcoidosis typically causes nonspecific osteolytic lesions that can mimic neoplasms (e.g., osteoblastoma, metastases, or multiple myeloma), osteomyelitis, or bone cysts [5,16]. In sarcoidosis involving the bone shaft like humerus and tibia, fractures may be more frequent due to pathologic disturbances and weakness in the bone architecture and there is concern that surgical repair will be difficult [5,20,21].…”

“…Bone sarcoidosis (BS) may mimic metastatic malignancy or different bone neoplasms, therefore biopsy is suggested to obtain confirmation of diagnosis [6,[11][12][13][14]. Sarcoidosis of the humerus is exceptionally rare and to date, only a few cases have been reported [5,[15][16][17]. In this mini-review, a case of enchondroma in proximal humerus mimicking sarcoidosis and the features of bone involvement of sarcoidosis were reviewed.…”