The diagnostic value of gastrocnemius muscle biopsy in sarcoidosis presenting with erythema nodosum and hilar adenopathy

Abstract

Five cases of sarcoidosis were identified among twenty cases of erythema nodosum, admitted to the Department of Medicine, during a two-year period. The clinical picture was dominated by hilar adenopathy and erythema nodosum in all cases. All five patients had gastrocnemius muscle biopsy performed, which revealed noncaseating epithelioid granuloma in four. Diagnosis in the fifth patient was made by transbronchial lung biopsy. The present study suggests, that gastrocnemius muscle biopsy might be considered as the initial diagnostic procedure of choice in this, more commonly seen in Caucasians, syndrome of sarcoidosis, presenting with hilar adenopathy and erythema nodosum, based on its safety, ease of performance and relatively high sensitivity and specificity.

Clinical and prognostic significance of muscle biopsy in sarcoidosis

“…Symptomatic muscle sarcoidosis is rare and occurs in less than one percent [3,4]. Non-caseating granulomas may be observed in the peripheral muscle biopsy of the sarcoidosis patients and thereby facilitate the diagnosis of sarcoidosis [5][6][7]. The contribution of muscle involvement to diagnostic and prognostic outcome is uncertain because firm data revealing the diagnostic significance of muscle biopsy and the clinical features of muscle involvement in sarcoidosis is scarce.…”

“…Several biopsy sites other than the lung have been used as alternatives for the tissue biopsy diagnosis of sarcoidosis. Muscle biopsy is a simple, reliable, and a conclusive diagnostic modality although previous studies have established indeterminate results [4][5][6][7][8]. Skeletal muscle biopsy may be considered as a clinical implement for diagnosis if other organ biopsy sites fail to provide an accurate histopathologic verification and to determine the muscle disease in sarcoidosis.…”