Abstract
We report a case of fulminant sarcoidosis in a 28-year-old man presenting with skin nodules, multifocal small and large joint arthralgias, and blurred vision. Characteristic bone, soft tissue, articular, and CNS findings were evident on multimodality imaging. Bony abnormalities included near-complete destruction of a distal phalanx, “lace-like” lucent lesions, erosive arthritis, lytic lesions with and without sclerotic margins, and bone marrow replacement visible only on MRI. The extent of bony disease at time of presentation was unusual. We review the widely varying reported prevalence of imaging findings of bony sarcoidosis in the literature, and discuss reasons for this variability. We found that musculoskeletal findings at US and MRI were less specific than radiographic and CT findings, but were useful in quantifying extent of disease.
Similar content being viewed by others
References
Govender P, Berman JS. The diagnosis of sarcoidosis. Clin Chest Med. 2015;36:585–602.
Baughman RP, Culver DA, Judson MA. A concise review of pulmonary sarcoidosis. Am J Respir Crit Care Med. 2011;183:573–81.
Baughman RP, Teirstein AS, Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001;164:1885–9.
Wanat KA, Rosenbach M. Cutaneous sarcoidosis. Clin Chest Med. 2015;36:685–702.
Wilcox A, Bharadwaj P, Sharma OP. Bone sarcoidosis. Curr Opin Rheumatol. 2000;12:321–30.
Yaghmai I. Radiographic, angiographic and radionuclide manifestations of osseous sarcoidosis. Radiographics. 1983;3:375–96.
Kobak S. Sarcoidosis: a rheumatologist’s perspective. Ther Adv Musculoskelet Dis. 2015;7:196–205.
Moore SL, Teirstein AE. Musculoskeletal sarcoidosis: spectrum of appearances at MR imaging. Radiographics. 2003;23:1389–99.
Glennas A, Kvien TK, Melby K, et al. Acute sarcoid arthritis: occurrence, seasonal onset, clinical features and outcome. Br J Rheumatol. 1995;34:45–50.
Sparks JA, McSparron JI, Shah N, et al. Osseous sarcoidosis: clinical characteristics, treatment, and outcomes—experience from a large, academic hospital. Semin Arthritis Rheum. 2014;44:371–9.
Aptel S, Lecocq-Teixeira S, Olivier P, Regent D, Gondim Teixeira P, Blum A. Multimodality evaluation of musculoskeletal sarcoidosis: imaging findings and literature review. Diagn Interv Imaging. 2016;97:5–18.
Moore SL, Kransdorf MJ, Schweitzer ME, Murphey MD, Babb JS. Can sarcoidosis and metastatic bone lesions be reliably differentiated on routine MRI? AJR Am J Roentgenol. 2012;198:1387–93.
Mostard RL, Prompers L, Weijers RE, et al. F-18 FDG PET/CT for detecting bone and bone marrow involvement in sarcoidosis patients. Clin Nucl Med. 2012;37:21–5.
James DG, Neville E, Siltzbach LE. A worldwide review of sarcoidosis. Ann N Y Acad Sci. 1976;278:321–34.
Shorr AF, Murphy FT, Gilliland WR, Hnatiuk W. Osseous disease in patients with pulmonary sarcoidosis and musculoskeletal symptoms. Respir Med. 2000;94:228–32.
Sohn M, Culver DA, Judson MA, Scott TF, Tavee J, Nozaki K. Spinal cord neurosarcoidosis. Am J Med Sci. 2014;347:195–8.
Bathla G, Singh AK, Policeni B, Agarwal A, Case B. Imaging of neurosarcoidosis: common, uncommon, and rare. Clin Radiol. 2016;71:96–106.
Tavee JO, Stern BJ. Neurosarcoidosis. Clin Chest Med. 2015;36:643–56.
Flanagan EP, Kaufmann TJ, Krecke KN, et al. Discriminating long myelitis of neuromyelitis optica from sarcoidosis. Ann Neurol. 2016;79:437–47.
Ahmed I, Harshad SR. Subcutaneous sarcoidosis: is it a specific subset of cutaneous sarcoidosis frequently associated with systemic disease? J Am Acad Dermatol. 2006;54:55–60.
Chen HH, Chen YM, Lan HH, Lee CH, Chen DY. Sonographic appearance of subcutaneous sarcoidosis. J Ultrasound Med. 2009;28:813–6.
Tada S, Watanabe T, Suzuki C, et al. Sonographic findings of subcutaneous sarcoidosis in 3 cases. J Ultrasound Med. 2015;34:1485–8.
Dybiec E, Pietrzak A, Bartosinska J, Kieszko R, Kanitakis J. Ultrasound findings in cutaneous sarcoidosis. Postepy Dermatol Alergol. 2015;32:51–5.
Nemoto I, Shimizu T, Fujita Y, Tateishi Y, Tsuji-Abe Y, Shimizu H. Tumour-like muscular sarcoidosis. Clin Exp Dermatol. 2007;32:298–300.
Goswami T, Siddique S, Cohen P, Cheson BD. The sarcoid-lymphoma syndrome. Clin Lymphoma Myeloma Leuk. 2010;10:241–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflict of interest.
Rights and permissions
About this article
Cite this article
Sweeney, A., Hammer, R., Evenski, A. et al. Fulminant musculoskeletal and neurologic sarcoidosis: case report and literature update. Skeletal Radiol 45, 1571–1576 (2016). https://doi.org/10.1007/s00256-016-2463-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-016-2463-y