Shah Kejal, Enabi Joud, Kondakindi Hema, Mukkera Srikanth
Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA.
Rheumatology, Texas Tech University Health Sciences Center, Odessa, USA.
Cureus. 2024 Jul 6;16(7):e63991. doi: 10.7759/cureus.63991. eCollection 2024 Jul.
Sarcoidosis is a systemic disease characterized by non-caseating epithelioid granulomas and can affect multiple organ systems, most commonly the lungs. Bone marrow involvement in sarcoidosis is rare and not well-documented. This case report details a 50-year-old female presenting with chronic lower back pain and significant hypercalcemia. Imaging revealed non-obstructive renal stones, liver nodularity, splenomegaly, and lung nodules. Initial treatments included corticosteroids for suspected sarcoidosis. Diagnostic workup, including bronchoalveolar lavage and various malignancy markers, was negative. A bone marrow biopsy showed non-caseating granulomas, confirming bone marrow sarcoidosis. This case underscores the importance of considering bone marrow involvement in patients with extrapulmonary sarcoidosis symptoms and highlights the need for a high index of suspicion among healthcare providers. Corticosteroids remain the primary treatment, with ongoing research into alternative therapies.
结节病是一种以非干酪样上皮样肉芽肿为特征的全身性疾病,可累及多个器官系统,最常见的是肺部。结节病累及骨髓较为罕见且文献记载不多。本病例报告详细介绍了一名50岁女性,她因慢性下背部疼痛和显著高钙血症就诊。影像学检查发现非梗阻性肾结石、肝脏结节、脾肿大和肺部结节。初始治疗包括使用皮质类固醇治疗疑似结节病。诊断性检查,包括支气管肺泡灌洗和各种恶性肿瘤标志物检查,结果均为阴性。骨髓活检显示非干酪样肉芽肿,确诊为骨髓结节病。本病例强调了在有肺外结节病症状的患者中考虑骨髓受累的重要性,并突出了医疗保健人员保持高度怀疑指数的必要性。皮质类固醇仍然是主要治疗方法,同时正在对替代疗法进行研究。