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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 A

DOI: 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 yearAge (years)/sex/raceClinical presentationLatency period between thoracic disease diagnosis and vertebral disease onsetTreatmentOutcome
Abdalla et al, 2019 []4 44/Male/WhiteA 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 sarcoidosis9 years. Initial thoracic disease was asymptomatic and never required medical treatmentMethotrexate (20 mg subcutaneously weekly) and prednisolone (5 mg daily) for 2 monthsSignificant 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/unspecifiedA 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 diagnosis16 years. Initial thoracic disease resolved spontaneously without active symptoms in the interim yearsOral prednisone (40 mg daily) for one month following by a slow taperingClinical improvement with resolution of pulmonary lesions on follow-up imaging
Mehrotro et al, 2011 []8 59/Female/unspecifiedA clinically silent and incidentally diagnosed multisystemic sarcoidosis with extensive osseous, hepatic, and pulmonary lesions simulating widespread metastatic diseaseConcurrent diagnosis of asymptomatic pulmonary and vertebral diseasesNot treated as the disease was clinically silent and only incidentally diagnosedPatient was asymptomatic. Follow-up was unspecified in the report
Bel-Ange et al, 2018 []9 55/Female/unspecifiedWorsening 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 sarcoidosisNo known previous sarcoidosis No evidence of concurrent thoracic disease as per imagingOral prednisolone (dose and duration unspecified). Steroids held as patient had avascular necrosis of the femurFollow-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 AmericanA 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 testConcurrent diagnosis of asymptomatic pulmonary diseaseOral prednisolone (40 mg for 2 months) followed by a slow taperingRemarkable clinical resolution and disappearance of radiological lesions on follow-up imaging at 2 months
Rahmouni et al, 2020 []16 65/Female/WhiteAn 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 involvement7 years Known Stage I thoracic disease with no active sarcoidosis symptoms during interim periodOral 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 diseaseInitially 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)

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923