Symptomatic rib lesions as the primary presentation of sarcoidosis. Report of two cases and review of literature.

Skeletal involvement in sarcoidosis is considered a manifestation of chronic disease. Rib lesions, while rarely reported, have been usually asymptomatic and often associated with vertebral sarcoidosis. Here, we report two patients with symptomatic rib lesions in sarcoidosis. Both patients were black males. In both cases, chest X-rays lacked characteristics of pulmonary sarcoidosis. A definite diagnosis was made on rib biopsies and confirmed by the positive Kveim test. One case was particularly interesting in that low back pain preceded the right hilar adenopathy for many years. This suggests that sarcoidosis involving the bone may occur at early stage of disease, and that low back pain in young male may be the first presentation of sarcoidosis. A literature review of osseous involvement in sarcoidosis reveals that skeletal lesions in sarcoidosis may preferentially manifest in the axial skeleton in some individuals.