Bone Sarcoidosis Research Articles

Primary Sarcoidosis of the Temporal Bone a Clinical Pathologic Correlation.

This report describes a case of sarcoidosis that presented as a lytic bone lesion in the squamous part of the temporal bone. A 64-year-old woman presented with right-sided aural fullness, pulsatile tinnitus, and intermittent otalgia. CT and MRI were performed without contrast and suggested an osseodestructive, lytic bone lesion. An excisional biopsy was performed, showing granulomatous infiltration suggestive of osseous sarcoidosis. Removal of mass and resolution of symptoms. Initial findings from patient imaging suggested a lytic bone lesion. An excisional biopsy was required for diagnosis and was performed with little patient morbidity. Biopsy findings showed granulomatous infiltration suggestive of osseous sarcoidosis. Osseous involvement of sarcoidosis is a rare manifestation and typically occurs secondary to other disease manifestations. After the removal of the mass and a short unrelated course of steroids, the patient's symptoms resolved. Sarcoidosis should be added to the differential diagnosis of lytic bone lesions in the temporal bone.

Imaging Plays a Key Role in the Diagnosis and Control of the Treatment of Bone Sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown origin. The most frequent localizations are thoracic lymph nodes and/or parenchymal lung disease, nevertheless any other organ may be involved. Musculoskeletal sarcoidosis, previously considered a rare manifestation of the disease, is presently recognized with increasing frequency, due to the development of modern imaging modalities. The classical X-ray sign of bone sarcoidosis is the image of lace in the phalanges of the hands. Most other locations present with atypical radiological images. Therefore, they may mimic metastatic neoplastic disease, especially when they are the first sign of sarcoidosis not previously recognized. On such occasions, none of the imaging methods will give the correct diagnosis, histopathological verification, monitoring of lesions or clinical data in a patient with confirmed sarcoidosis are indicated. The article summarizes the current status of knowledge concerning the recognition and therapy of bone sarcoidosis. In addition, an illustrative case of patient with bone and bone marrow sarcoidosis is presented.

Vertebral sarcoidosis: diagnosis to management

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.

Osseous sarcoidosis with fingers distal phalanx autoamputation in a treatment-naïve case

We report a case of a 55-year-old female, with 3 years history of a treatment-naive sarcoidosis involving lungs with second-stage sarcoidosis, skin in form of lupus pernio, and bones with multiple cystic areas of the digital bones, soft tissue swelling, nails dystrophy and missed phalanges. Uveitis frequently associated with bone sarcoidosis, was absent in our patient. Prior to attend to our clinic, she had been treated with short courses of nonsteroidal anti-inflammatory drugs and analgesics. No long-term corticosteroids therapy had been reported. Osseous lesions led to autoamputation of distal phalanges of two fingers. It is a very rare complication of unclear mechanism; however, they have been attributed by Several authors to long-term corticosteroid therapy, hypothesis not supported by our findings. Systemic corticosteroids are considered as standard medication. There are no firm guidelines for dosage and period of the treatment. Steroidsparing agents are often added mainly methotrexate, in some patients, biologics can be considered. Unfortunately for our patient, there was not enough time for management as she died lately

Sacroiliac joint in sarcoidosis on computed tomography: a monocentric retrospective study (SISTER).

Sacroiliitis and spondyloarthritis (SpA) have been associated to sarcoidosis. Sarcoidosis bone involvement of the sacral or iliac bones has been reported to mimic SpA. We aimed to evaluate the prevalence of structural sacroiliitis and structural changes of the sacroiliac joints (SIJ) in patients with sarcoidosis by abdominal-pelvic computed tomography (AP-CT). In this monocentric retrospective study, three blinded readers evaluated AP-CT that had already been performed on patients with sarcoidosis and classified them as normal, degenerative, or inflammatory. A consensus was reached for the divergent cases. Erosion, ankylosis, and sclerosis, classically associated with sacroiliitis, were noted. SpA was defined according to the ASAS 2009 classification criteria. We identified 217 patients with proven sarcoidosis who underwent AP-CT. Only three patients had sacroiliitis by CT and four had SpA, representing 1.38% and 1.85% of the patients, respectively. Degenerative SIJs represented 28.1% of patients and were significantly associated with age, at least one pregnancy, rural lifestyle, ankylosis, diffuse idiopathic skeletal hyperostosis, sclerosis, and the presence of osteophytes. Four patients had axial bone sarcoidosis. Sacroiliitis, SpA, and degenerative changes of the SIJ have been highlighted by AP-CT in patients with sarcoidosis. Osteoarthritis of the SIJ in sarcoidosis was associated with age, pregnancy, and rural lifestyle. Further studies are needed to assess the link between SpA and sarcoidosis.

Sarcoidosis of the mandibular condyle manifesting as a temporomandibular joint arthrosis: A rare case report

AbstractBone sarcoidosis is uncommon, and involvement of the temporomandibular joint is exceptionally rare. We report an unusual case of mandibular condyle sarcoidosis in a 51‐year‐old Japanese woman that manifested as a temporomandibular joint arthritis. The patient was referred for a chief complaint of a painful temporomandibular joint and was initially diagnosed with temporomandibular joint arthritis. However, a more detailed examination revealed bone sarcoidosis in the mandibular condyle and the progression of preexisting cardiac sarcoidosis. Oral steroid treatment (tapered from 50 mg/day to 5 mg/day) appears to have been successful over a 1‐year follow‐up.

Multiple bone lesions in a patient with fatigue: case report of bone sarcoidosis

ABSTRACT Bone sarcoidosis is usually considered a rare manifestation of multisystemic sarcoidosis. With the growing use of more sensitive imaging techniques, such as 18F-FDG PET, the detection rate of bone involvement seems to be increasing. We describe the case of a woman presenting with fatigue and general malaise having multiple bone lesions on 18F-FDG PET. A broad range of differential diagnoses was considered, including malignancy, infections, metabolic diseases and primary bone tumours, which may have delayed the diagnosis. Diagnostic work-up eventually led to an anatomopathological diagnosis of bone sarcoidosis. Immunosuppressive therapy is often necessary since sarcoid bone lesions – even asymptomatic – generally appear in more extensive forms of the disease with other organ involvement.

Concurrent diagnosis of oropharynx cancer and bone sarcoidosis mimicking metastasis

Bone location is uncommon in both sarcoidosis and in neck cancer (HNC). Diagnosis of a bone lesion is therefore challenging to distinguish its nature in a patient suffering from both diseases. We report the case of a 69-years-old woman referred for P16 positive HPV-HNC. Magnetic Resonance Imaging (MRI) showed T2 hypo-signal on iliac crest and spine. 18FDG-PET demonstrated radiotracer uptake on these locations suggesting bone metastasis. However, bone biopsy showed epithelioid granuloma without malignant cells compatible with sarcoidosis location. The diagnosis of both localized advanced HPV-HNC and systemic sarcoidosis (bone, central nervous system) were retained. The patient received corticosteroid regimen at 0.5mg/kg/day and Methotrexate for sarcoidosis and radiation and chemotherapy with platins for carcinoma. As granulomatous bone marrow infiltration may have an uptake on 18FDG-PET, bone sarcoidosis can mimic metastatic disease. In addition, MRI often fails to distinguish sarcoidosis lesions from metastatic lesion in bones. As no reliable imaging test can decipher both diseases, the description of our case reinforces the necessity to perform bone biopsy in a patient suffering from both conditions to expertise the nature of bone lesions.

18F-FDG PET/CT in bone sarcoidosis: an observational study.

Bone sarcoidosis is usually rare. Imaging procedures such as fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) can reveal bone sarcoidosis with better sensitivity than conventional radiography. We aimed to describe bone sarcoidosis involvement detected with 18F-FDG PET/CT. This was an observational retrospective study of individuals with pulmonary sarcoidosis who underwent 18F-FDG PET/CT. According to the ATS/ERS/WASOG criteria, sarcoidosis was diagnosed by the presence of clinical and/or imaging features of sarcoidosis and evidence of non-caseating epithelioid granulomas on a biopsy. We assessed clinical and 18F-FDG PET/CT characteristics. Data for 85 patients with sarcoidosis (56.5% female, median age 47 [range 21-80] years) were analyzed. The median follow-up was 4years. Among 56 patients, sarcoidosis occurred in more than three organs. According to ATS/ERS/WASOG criteria, bone sarcoidosis was diagnosed in 12 (14%) patients. The spine was the most commonly affected location (92%, n = 11), followed by the pelvis (67%, n = 8), sternum (33%, n = 4), humerus (25%, n = 3), and fingers (17%, n = 2). Only peripheral adenopathy was associated with bone sarcoidosis (p = 0.04). Seven patients had a 18F-FDG PET/CT follow-up, all showing a decrease of bone lesions. Bone sarcoidosis occurred in 14% of patients with sarcoidosis, affecting multiple bones and mostly the axial skeleton. 18F-FDG PET/CT seems a sensitive tool for diagnosis and follow-up of bone sarcoidosis.

A narrative literature review on the diagnostic and therapeutic intervention approaches of polyostotic fibrous dysplasia in bones: A bangladeshi case report

Background: Fibrous dysplasia (FD) is a less common benign bony fibro-osseous lesion, which is divided into two main kinds: monostotic FD and polyostotic FD (PFD). The natural history or aetiopathogenesis of FD is poorly understood, and treatments are still controversial. Methods: A review of the literature was performed to analyse and discuss the diagnosis and management of FD through a case report and literature review. Results: The current case of a PFD patient, which is usually presented in late childhood or early adulthood, is sometimes associated with endocrine disorders such as McCune–Albright syndrome (MCA). Computed tomography-guided biopsy from the lytic bone area is a useful technique for the evaluation and diagnosis of disease, though the accuracy of the histopathology findings has been not conclusive. Exclusion of other lytic bone lesion disease is the mainstay of diagnosis. All medical and surgical treatments are valid; no one has been proven to be better. The present case is reported because it illustrates specific points of differential diagnosis, such as multiple myeloma, hyperparathyroidism, primary bone malignancy, secondary metastasis in bones, sarcoidosis or granulomatous disease of bone. Conclusions: In the current case, surgical repair of the bone is not possible due to extensive involvement in different sites of the bones, and there is no mechanical compression in any neurological structures, hence medical management was chosen. There is no gold standard in medical or surgical treatment, and each treatment should be individualised. Only medical management shows good results in such cases.

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

Sarcoidosis of the humerus is exceptionally rare and only a few cases have been reported. In this mini-review, a case of enchondroma in proximal humerus mimicking sarcoidosis and the features of bone involvement of sarcoidosis were reviewed. A 41-year-old female who was diagnosed with sarcoidosis in 2009 had used corticosteroids for 4 months. She had not any symptoms until 2014. She was admitted the clinic with a 2-month-history of erythema nodosum on her legs and right shoulder pain. Values of laboratory tests were all within normal limits except erythrocyte sedimentation rate and C-reactive protein levels. The mass in the proximal metaphyseal humerus has the characteristic as a medullary lesion which had calcifications in CT sections. MR images that the mass had low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images. It had irregular nodular contrast and the mass did not cause the expansion of the bone. Increased activity was observed on scintigraphy. We suspected the mass which was realized incidentally in a patient with sarcoidosis, could be bone sarcoidosis. As a result of our biopsy, it was enchondroma. Bone neoplasms should be kept in mind in issues like our case report.

A case report; Bone sarcoidosis of the phalanx which initial manifestation was refractory fistula

A case report; Bone sarcoidosis of the phalanx which initial manifestation was refractory fistula

Clinical characteristics of patients with bone sarcoidosis.

To assess the clinical features, diagnosis, and treatment of bone sarcoidosis in the United States. Patients with bone sarcoidosis were identified and matched to sarcoidosis patients based on race, gender, and age. Detailed characteristics were obtained by medical record review. A total of 64 patients with bone sarcoidosis were enrolled in this study. The female:male ratio was 1.46:1 and the white:black ratio was 3:1. Thirty-eight (59.4%) of 64 patients had bone symptoms. Compared to matched cases, bone sarcoidosis patients have more multi-organ involvement and higher incidence with liver, spleen, and extrathoracic lymph node involvement than controls (P < 0.05). Spine was the most commonly affected bone in 44 (68.8%) of patients, followed by pelvis (35.9%), and hands (15.6%). MRI and PET/CT scan was the common imaging technology, which performed in 36 patients and 32 patients, respectively, and with 97.2% and 93.8% positive bone uptake. Laboratory test indicated anemia was more common in bone sarcoidosis group than controls (P = 0.044). Infliximab was more commonly used in bone sarcoidosis patients than controls (P = 0.009). Bone sarcoidosis was associated with multi-organs affection, and high frequency of liver, spleen, or extrathoracic lymph node involvement. Infliximab should be considered in those patients with aggressive and refractory bone sarcoidosis.

Prevalence and clinical picture of musculoskeletal sarcoidosis.

Background:Sarcoidosis is a multisystem disease affecting different organs with different frequency rates depending on geographical location. Musculoskeletal abnormalities includes osseous lesions (small and large bone sarcoidosis), sarcoidal arthropathy, and sarcoidal myopathy. Musculoskeletal involvement is reported in a significant number of patients.Objectives:This study aimed to determine the prevalence and clinical picture of musculoskeletal sarcoidosis in Iranian cohort of patients with sarcoidosis.Patients and Methods:We designed a descriptive cross-sectional study including 30 patients with sarcoidosis who had hospitalized in the Rheumatology Department at Ghaem Hospital, Mashhad, Iran. The patients were evaluated for musculoskeletal symptoms using history, physical examination, and paraclinical data.Results:Of the 30 studied patients, 24 were female (80%) and six were male (20%). The mean age at diagnosis was 38 years. Sarcoidal arthropathy (arthritis and periarthritis) was observed in 26 patients (86.6%). Furthermore, the initial presentation was associated with joint symptoms in 19 cases (63.3%); acute arthritis developed in 17 (65%) while bone and muscle involvements each occurred in 2 (6.6%).Conclusions:Sarcoidosis is a common disease in women aged 20 to 40 years. The most common involved joint were consecutively ankles, knees, and wrists, reaching a accumulated frequency of 86.6%; however, bone and muscle involvements were uncommon.

Sarcoidosis of the Spine

Sarcoidosis, also called Morbus Boeck disease , is a potentially systemic disease defined by noncaseating granulomatous inflammation of uncertain etiology1. The natural history of sarcoidosis is unpredictable as it can involve one or multiple organ systems and it can be progressive or resolve spontaneously. While sarcoidosis has been described as affecting most organ systems, the lungs are involved in >90% of cases2. Skeletal involvement is much less frequent; the prevalence has been reported to range from <1% to 13%2,3. The small bones of the hands and feet are most often involved, whereas spinal disease is rare4. Most patients with spinal sarcoidosis present with axial pain that resolves either on its own or after the administration of corticosteroids. However, pathologic fractures have been reported with associated neurologic sequelae5,6. We report the clinicopathologic features of five patients with sarcoidosis involving the spine. The Massachusetts General Hospital Institutional Review Board reviewed and approved this study. We searched our bone sarcoma registry to identify all patients diagnosed with sarcoidosis of the spine from 1980 through 2007. In addition, we utilized our Department of Pathology database to search for pertinent cases. Inclusion criteria were the diagnosis of sarcoidosis, confirmed with a bone biopsy of the spine, and a minimum duration of follow-up of two years. The initial group included thirteen patients. One patient was excluded because there was no histological evidence of bone sarcoidosis. We also excluded five patients who had bone sarcoidosis but not of the spine. Two patients were excluded because of a lack of sufficient follow-up. This left a cohort of five patients with sarcoidosis of the spine who formed the final study group, and we reviewed their medical records, radiographs, and pathology reports. The tissue specimen from each case …

Sarcoidosis of bone. Findings in the Gallium citrate examination

Sarcoidosis of bone lesions are rare, with an overall incidence of 3–9% of the cases. When they do occur, they are more frequent in the small bones of hands and feet than in long bones, spine or skull. We report a case of a male patient with sarcoidosis with multiple enlarged lymph nodes, skin and bone lesions, and the scintigraphic findings.

治療を要した骨サルコイドーシス４例の臨床的検討

症状を伴う骨サルコイドーシスは，サルコイドーシス症例の１～２％と比較的稀である．当科で経験した骨サルコイドーシス４例の特徴について検討した．４例とも多臓器に病変を有し，骨病変発症までの罹病期間が長い傾向にあった．骨病変部位は四肢末端に多かった．骨病変の分布を把握するには骨シンチグラフィーが有用であった．また診断にはMRIが有用であり，いずれの症例もT1強調画像にて低信号を示した．治療に関しては４例中３例がステロイド投与にてすみやかに症状の改善が認められた．真菌感染症のためにステロイドが使用できなかった１例では，イトラコナゾール投与後に感染症の改善とともに骨病変の改善が認められた．４例とも治療介入にて症状の改善が認められており，病的骨折予防のためにも早期診断，早期治療が重要であると考えられた．

Rare localizations of bone sarcoidosis: two case reports and review of the literature

Sarcoidosis is a multisystem disease of unknown origin. Granulomatous bone involvement has an overall incidence of 1-13%. This incidence is probably underestimated in certain patient series because bone involvement is 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 describe some interesting cases of chronic sarcoidosis with unusual bone localizations observed at our regional referral centre for sarcoidosis. We also review the literature to underline the complexity of the disease, the problem of differential diagnosis with respect to malignancies and the need for appropriate and effective therapy of this rare localization.

Explaining sarcoidosis of bone

The radiographic features of sarcoidosis of bone are such as to suggest a possible infection as a cause of the lesions. This article explains how such lesions can be explained without resorting to a hypothesized infection as the etiology. Accepting that sarcoidosis definitely is not an infection is important for clinicians because not doing so can result in treatment errors.

Diffuse Spine Involvement in Sarcoidosis With Sternal Lytic Lesions

Case report. To report 2 cases of sarcoidosis with a diffuse vertebral involvement, associated with a rare location in the sternum. Sarcoidosis is a systemic disease of unknown cause with various clinical and radiologic manifestations. Bone involvement is rare (1%-13% of cases). Vertebral involvement is very uncommon. Lytic lesions, sclerotic lesions, or both of these patterns may be observed. One patient complained of diffuse bone pain; the second patient was asymptomatic. Each patient had radiograph, CT, and MRI of the spine. The second patient also underwent a PET/CT FDG-(18F). Sternal bone biopsy was performed in both patients. Pathologic findings indicated typical pattern of bone sarcoidosis. Clinical and biologic improvement was noticed after treatment with corticosteroids. In our 2 cases, radiograph, CT, MRI, and PET/CT findings were evocative of diffuse spine involvement in sarcoidosis associated with sternal lytic lesions. This suspicion was confirmed by histopathologic findings, which found a typical pattern of sarcoidosis. These 2 cases emphasize the value of CT, MRI, and FDG-(18F) PET/CT for the diagnosis of diffuse spinal involvement in sarcoidosis and describe an exceptional association with sternal lytic lesions.