Osseous sarcoid with lytic lesions in skull

Sarcoidosis bone is uncommon, and involvement of the skull is exceptionally rare. We present a 65-year-old obese female who presented with a 2-month history of dryness of mouth, polyuria, fatigue, and anorexia. She had generalized lymphadenopathy, organomegaly, and hypercalcemia, and a skeletal surv...

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Bibliographic Details
Published in:Rheumatology international 2014-04, Vol.34 (4), p.579-582
Main Authors: Suri, V., Singh, Abhijai, Das, Reena, Das, Ashim, Malhotra, P., Jain, S., Kumari, S., Khandelwal, N., Varma, S.
Format: Article
Language:English
Subjects:
Administration, Oral
Adrenal Cortex Hormones - administration & dosage
Aged
Bone Diseases - diagnosis
Bone Diseases - drug therapy
Bone Diseases - pathology
Diagnosis, Differential
Female
Humans
Medicine
Medicine & Public Health
Osteolysis - diagnosis
Osteolysis - drug therapy
Osteolysis - pathology
Predictive Value of Tests
Rheumatology
Sarcoidosis, Pulmonary - diagnosis
Sarcoidosis, Pulmonary - drug therapy
Sarcoidosis, Pulmonary - pathology
Short Communication
Skull - drug effects
Skull - pathology
Time Factors
Treatment Outcome
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Summary:Sarcoidosis bone is uncommon, and involvement of the skull is exceptionally rare. We present a 65-year-old obese female who presented with a 2-month history of dryness of mouth, polyuria, fatigue, and anorexia. She had generalized lymphadenopathy, organomegaly, and hypercalcemia, and a skeletal survey revealed extensive osteolytic lesions in the skull and phalanges. Both lymph node biopsy from the cervical lymph node and bone marrow examination revealed non-caseating granulomas, suggesting sarcoidosis. She was started on 1 mg/kg oral corticosteroids; during a follow-up of 6 months, she achieved normocalcemia; however, the punched-out lesions in the skull remained unchanged. This case reiterates several important issues that all lymphadenopathy in emerging nations may not be tubercular, and presence of osteolytic lesions in skull are unusual for sarcoid, at an elderly age, necessitates evaluation for more common etiologies like metastases and myeloma. Finally, patients with osseous sarcoid should be on a close follow-up since due to the rarity of this presentation, no definite consensus on the management of such cases exists in the literature.
ISSN:0172-8172
1437-160X
DOI:10.1007/s00296-013-2752-x