07 February 2022>: Articles
Multisystemic Sarcoidosis Presenting with Widespread Vertebral Osseous and Visceral Lesions Masquerading as Metastatic Disease: A Case Report and Literature Review
Challenging differential diagnosis, Rare disease
Eltaib Saad A* , Mohamed Agab A , Qishuo Zhang B , Goar Egoryan E , Akram Babkir E , Dorota Filipiuk ADOI: 10.12659/AJCR.935158
Am J Case Rep 2022; 23:e935158
Table 1. Summary of patient characteristics and clinical features of cases of multisystemic sarcoidosis with vertebral osseous disease in the literature.
Authors/publication year | Age (years)/sex/race | Clinical presentation | Latency period between thoracic disease diagnosis and vertebral disease onset | Treatment | Outcome |
---|---|---|---|---|---|
Abdalla et al, 2019 []4 | 44/Male/White | A 2-month history of fatigue, night sweats, weight loss, anorexia, and abdominal discomfort.Imaging showed extensive hepatic, renal, lymphatic, and vertebral osseus. lesions simulating advanced metastatic diseases. Bony biopsy (T12 body) confirmed sarcoidosis | 9 years. Initial thoracic disease was asymptomatic and never required medical treatment | Methotrexate (20 mg subcutaneously weekly) and prednisolone (5 mg daily) for 2 months | Significant clinical and radiological improvement. A 2-month follow-up imaging revealed resolution of vertebral, lymphatic, and hepatic lesion |
Packer et al, 2005 []5 | 47/Male/unspecified | A 4-month history of worsening lower backpain.Imaging showed lytic thoracic and lumbar vertebral lesions and multiple pulmonary nodules with hilar and lymphadenopathy. Bony biopsy (L4 body) confirmed the diagnosis | 16 years. Initial thoracic disease resolved spontaneously without active symptoms in the interim years | Oral prednisone (40 mg daily) for one month following by a slow tapering | Clinical improvement with resolution of pulmonary lesions on follow-up imaging |
Mehrotro et al, 2011 []8 | 59/Female/unspecified | A clinically silent and incidentally diagnosed multisystemic sarcoidosis with extensive osseous, hepatic, and pulmonary lesions simulating widespread metastatic disease | Concurrent diagnosis of asymptomatic pulmonary and vertebral diseases | Not treated as the disease was clinically silent and only incidentally diagnosed | Patient was asymptomatic. Follow-up was unspecified in the report |
Bel-Ange et al, 2018 []9 | 55/Female/unspecified | Worsening right hip and leg pain. Imaging revealed multifocal multi-level vertebral lesions.Extensive diagnostic work-up with thoracoabdominal imaging was negative for possible malignancy. Bony biopsy (L4 body) confirmed sarcoidosis | No known previous sarcoidosis No evidence of concurrent thoracic disease as per imaging | Oral prednisolone (dose and duration unspecified). Steroids held as patient had avascular necrosis of the femur | Follow-up imaging at 5 months with disappearance of all spinal lesions. Recurrence of lesions when steroids held |
Mangino et al, 2003 []10 | 42/Male/African American | A challenging thoracic backpain for 8 months which was associated with lower-grade fever and night sweating. Referred for oncology evaluation. Imaging revealed thoracic vertebral lesions with para-vertebral mass concerning for malignancy. Open biopsy of the mass and a bony lesion revealed soft tissue and bony sarcoidosis, respectively. Thoracic imaging revealed mild para-tracheal and para-hilar lymphadenopathy with a normal lung function test | Concurrent diagnosis of asymptomatic pulmonary disease | Oral prednisolone (40 mg for 2 months) followed by a slow tapering | Remarkable clinical resolution and disappearance of radiological lesions on follow-up imaging at 2 months |
Rahmouni et al, 2020 []16 | 65/Female/White | An ongoing mechanical lower back pain with general malaise for 2 years.Imaging revealed thoracic disease with osteolytic vertebral osseous lesion.Bone biopsy (L2 body) confirmed osseus involvement | 7 years Known Stage I thoracic disease with no active sarcoidosis symptoms during interim period | Oral prednisolone (40 mg) was prescribed initially but patient did not take it due to lack of resources. Oral prednisolone was given on readmission for thoracic disease | Initially lost follow-up for almost 1 year. Readmission after 1 year with persistent thoracic disease with disappearance of vertebral lesions (apparently without specific treatment suggesting spontaneous remission as per authors of that report) |