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Sarcoidosis-associated acro-osteolysis
  1. Vishal Patel1,
  2. Robert Case1,
  3. Saminder Kalra2 and
  4. Divya Patel2
  1. 1Department of Medicine, Division of Internal Medicine, University of Florida, Gainesville, Florida, USA
  2. 2Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Vishal Patel; vishal.patel2{at}medicine.ufl.edu

Abstract

Sarcoidosis is characterised by the formation of noncaseating granulomas classically affecting lungs, lymph nodes and skin. Osteoarticular involvement affects up to 15% of patients; however, acro-osteolysis, destruction involving distal phalanges of fingers and toes, associated with sarcoidosis, is extremely rare. A 44-year-old woman with a history of biopsy-proven sarcoidosis managed with prednisone and methotrexate presented with swelling and pain in the distal fingers of her right hand without skin manifestations. Radiographic imaging showed erosion of distal phalanges on second, third and fifth fingers and bone resorption in bilateral toes. A biopsy of the finger lesions showed noncaseating granulomas consistent with sarcoidosis. She was diagnosed with sarcoid acro-osteolysis and started on adalimumab with clinical and radiographic improvement. While most cases of osteoarticular sarcoidosis are asymptomatic and respond to standard immunosuppression, we present a case with progressive and refractory clinical course. This is the first reported case of sarcoid acro-osteolysis affecting the toes.

  • musculoskeletal syndromes
  • biological agents
  • respiratory medicine
  • pathology
  • musculoskeletal and joint disorders

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Footnotes

  • Twitter @DivyaCPatelDO

  • Contributors All authors participated and contributed in the authorship and review of this case. VP and RC drafted the manuscript, and SK and DP edited and finalised the manuscript. VP obtained informed consent from patient. DP reviewed final submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.