Hameed Omair Akhtar, Skibinska Malgorzata
General Medicine Department, Basildon University Hospital, London, Essex, UK.
BMJ Case Rep. 2011 Dec 20;2011:bcr0220113863. doi: 10.1136/bcr.02.2011.3863.
Sarcoidosis affects the lungs most commonly and can present with cutaneous lesions. It can also involve the bone marrow in rare instances, often presenting with non-specific symptoms such as fever and malaise, with occasional haematological abnormalities. The authors present the case of a 41-year-old caucasian female who was diagnosed with scar sarcoidosis, but who also reported fatigue, night sweats and polyarthralgia. No haematological abnormalities or lung involvement were detected. A magnetic resonance scan of the spine, performed due to disc prolapses, demonstrated areas of bone oedema and stress response that were reported as a possible sarcoid infiltration of the bone marrow. An improvement occurred after 8 weeks, despite conservative treatment. Bone marrow involvement in sarcoidosis is rarely reported, and was an accidental finding here. Due to the non-specific presentation, cases such as this are potentially underdiagnosed and should be considered in patients with systemic symptoms, regardless of their haematological status.
结节病最常累及肺部,也可出现皮肤病变。在罕见情况下,它还可累及骨髓,常表现为发热和不适等非特异性症状,偶尔伴有血液学异常。作者报告了一例41岁的白种女性病例,该患者被诊断为瘢痕结节病,但她也自述有疲劳、盗汗和多关节痛症状。未检测到血液学异常或肺部受累情况。因椎间盘突出进行的脊柱磁共振扫描显示有骨水肿和应激反应区域,报告认为这可能是结节病对骨髓的浸润。尽管采取了保守治疗,但8周后病情有所改善。结节病累及骨髓的情况鲜有报道,此处属于偶然发现。由于临床表现不具特异性,此类病例可能未得到充分诊断,对于有全身症状的患者,无论其血液学状况如何,均应考虑到这种情况。