Disabling Bilateral Hip Disease and Femoral Bone Defects Revealing Systemic Sarcoidosis

Abstract

Introduction: Bone involvement in sarcoidosis is rare and often asymptomatic. The small bones of hands and feet are the most common localizations, while skull, knee, rib, pelvic and sternal localizations are rarely reported. Here we report a hip localization. Case: A 52-year-old woman consulted for acute bilateral coxopathy. Chest radiography objectified bilateral interstitial syndrome with mediastinal lymphadenopathy. The X-ray of the pelvis and both hips showed no abnormalities and CT scan revealed a moth-eaten osteolytic lesion of the left femoral head. It was associated with inflammatory syndrome and cholestasis. Liver biopsy revealed epithelioid and giant cell granulomas without caseous necrosis. The pathology specimens were interpreted as representing sarcoid. Conclusion: Well, this observation of systemic sarcoidosis, authenticated by histological evidence, seems original mostly because of its revealing clinical presentation of the disease, with violent bilateral coxopathy and total functional disability, but also radiological, with an aspect of moth-eaten osteolysis of the femoral head. No similar cases have been reported in the literature.