Spontaneous improvement of sarcoidosis mimicking a vertebral metastatic lesion: It's indeed possible!

Rahmouni, S.; Maatallah, Kaouther; Ferjani, H.; Riahi, Hend; Manamani, Lamia; Kaffel, Dhia; Hamdi, Wafa

doi:10.1002/ccr3.3172

Cited by 5 publications

(9 citation statements)

References 12 publications

(26 reference statements)

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“…There is no consensus presently for the management of vertebral sarcoidosis owing to the rarity of the disease [ 15 , 16 ]. Medical treatment is reserved for symptomatic patients with pain and bone destruction [ 4 , 5 , 16 ]. Systemic corticosteroids remain the main modality of treatment of osseous sarcoidosis [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, long-term treatment for resistant osseus disease includes methotrexate, hydroxychloroquine, and anti-tumor necrosis factor therapy [ 15 ]. Interestingly, a spontaneous resolution of vertebral sarcoidosis was described in the 2 cases that documented a radiological resolution of the previously reported vertebral lesions without medical intervention [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Multisystemic Sarcoidosis Presenting with Widespread Vertebral Osseous and Visceral Lesions Masquerading as Metastatic Disease: A Case Report and Literature Review

et al. 2022

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Patient: Female, 78-year-old Final Diagnosis: Multisystem sarcoidosis with visceral and vertebral disease • sarcoidosis Symptoms: Weaknes of lower limbs Medication:— Clinical Procedure: — Specialty: Rheumatology Objective: Rare disease Background: Sarcoidosis is a systemic granulomatous disease which predominantly affects the lungs, skin, and lymph nodes. Vertebral sarcoidosis is a rare entity. The clinical presentation of sarcoidosis with diffuse vertebral osseous and visceral lesions, simulating a disseminated metastatic cancer, is extremely unusual and has been reported only in a handful of cases in the current literature. Case Report: A 78-year-old White female patient with a remote history of asymptomatic pulmonary sarcoidosis presented with a 1-month history of generalized weakness. Physical examination was positive for upper and lower midline spinal tenderness. Laboratory findings showed anemia, hypercalcemia, and deranged liver functions. Abdominal imaging revealed an enlarged and nodular liver, ascites, splenomegaly, and enlarged retroperitoneal lymph nodes. Spinal imaging demonstrated several multi-level vertebral osseous lesions suspicious for metastatic bone cancer. Following extensive diagnostic work-up to rule out underlying metastatic cancers, a bone biopsy from an iliac lesion demonstrated active non-caseating granulomas, and a diagnosis of multisystemic sarcoidosis was made. The patient was started on systemic corticosteroids and demonstrated a gradual symptomatic improvement. Follow-up imaging revealed interval resolution of vertebral lesions. Conclusions: The clinical and radiological features of vertebral sarcoidosis can be indistinguishable from metastatic bone cancers. The possibility of widespread extrapulmonary sarcoidosis should be considered in any patients with a remote history of pulmonary sarcoidosis who experience simultaneous onset of unexplained multisystemic symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multisystemic Sarcoidosis Presenting with Widespread Vertebral Osseous and Visceral Lesions Masquerading as Metastatic Disease: A Case Report and Literature Review

et al. 2022

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“…MRI helps to monitor the progression of patients under treatment, as depicted in various reports, with MRI abnormalities resolving following suc-cessful therapy (18,19). This outcome reflects the replacement of granulomas with a fibrous element, which is proof of recovery.…”

Section: Imaging Featuresmentioning

confidence: 94%

“…Osteosclerosis reflects the marrow infiltration and is usually seen in the late stages of the disease, often after longterm treatment (18). Other imaging features include ivory vertebra and isolated lytic lesions, mimicking metastases (19,20). Concomitant sacroiliitis was reported in 6% to 23.4% of cases in some series (21).…”

Section: Imaging Featuresmentioning

confidence: 99%

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Vertebral sarcoidosis: diagnosis to management

Ferjani¹,

Rahmouni²,

Nessib³

et al. 2022

Acta Orthop Belg

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Sarcoidosis is a systemic inflammatory granulomatous disease that can develop in almost any organ system. Rheumatologists may encounter sarcoidosis in different situations varying from arthralgia to bone involvement. While the peripheral skeleton was a frequent location, data regarding axial involvement is scarce. Most patients with vertebral involvement have a known diagnosis of intrathoracic sarcoidosis. They tend to report mechanical pain or tenderness over the involved area. Imaging modalities, particularly Magnetic Resonance Imaging (MRI), are a mainstay of axial screening. It helps exclude differential diagnoses and delineate the extent of bone involvement. Histological confirmation combined with the ap- propriate clinical and radiological presentation is the key of diagnosis. Corticosteroids remain the cornerstone of treatment. In refractory cases, methotrexate is the steroid- sparing agent of choice. Biologic therapies may be used, although the evidence base for their efficacy is bone sarcoidosis controversial.

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An uncommon presentation of a multifocal spinal osseous sarcoidosis: A case report on the diagnosis and exclusion with literature review

Gilman,

Burke,

Nolan

et al. 2024

Radiology Case Reports

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Spontaneous improvement of sarcoidosis mimicking a vertebral metastatic lesion: It's indeed possible!

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 5 publications

References 12 publications

Multisystemic Sarcoidosis Presenting with Widespread Vertebral Osseous and Visceral Lesions Masquerading as Metastatic Disease: A Case Report and Literature Review

Multisystemic Sarcoidosis Presenting with Widespread Vertebral Osseous and Visceral Lesions Masquerading as Metastatic Disease: A Case Report and Literature Review

Vertebral sarcoidosis: diagnosis to management

An uncommon presentation of a multifocal spinal osseous sarcoidosis: A case report on the diagnosis and exclusion with literature review

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