Tounsi Haifa, Skouri Wafa, Jlidi Mohamed, Bachrouch Sabrine, Mami Haifa, Kaabar Yassine, Sbaihi Siwar, Chaabane Abir, Amri Raja, Alaya Zeineb
Department of Internal Medicine, Mohamed Tahar Maamouri University Hospital, Nabeul, Tunisia.
Department of Orthopedic Surgery, Mohamed Tahar Maamouri University Hospital, Nabeul, Tunisia.
Radiol Case Rep. 2024 Sep 12;19(12):5744-5749. doi: 10.1016/j.radcr.2024.08.115. eCollection 2024 Dec.
Sarcoidosis is a systemic granulomatosis of unknown etiology. Mediastinal lymph node and pulmonary involvement are the most characteristic manifestations. However, bone involvement is rare during sarcoidosis. Herein, we describe an atypical case of sarcoidosis revealed by a severe hypercalcemia and lytic lesions of the skull without pulmonary or mediastinal manifestation. A 53-year-old woman was admitted for symptomatic hypercalcemia of 3.8 mmoL/L. The initial good course after hydration combined with a dose of intravenous zoledronate was followed by a relapse of hypercalcemia. Computed tomography (CT) scan showed 2 lytic lesions of the skull and multiple nodules and micronodules in the liver and the spleen which were of normal size. The histological examination showed a non-necrotizing granulomatous hepatitis, with no signs of malignancy. The bone marrow biopsy did not show any abnormality. Assessment for tuberculosis was negative. The diagnosis of sarcoidosis was considered. Oral prednisone therapy allowed total remission.
结节病是一种病因不明的全身性肉芽肿病。纵隔淋巴结和肺部受累是最典型的表现。然而，结节病累及骨骼的情况较为罕见。在此，我们描述了一例非典型结节病病例，该病例以严重高钙血症和颅骨溶骨性病变为表现，而无肺部或纵隔表现。一名53岁女性因3.8 mmol/L的症状性高钙血症入院。水化治疗联合一剂静脉注射唑来膦酸后最初病情好转，但随后高钙血症复发。计算机断层扫描（CT）显示颅骨有2处溶骨性病变，肝脏和脾脏有多个结节及微小结节，大小正常。组织学检查显示为非坏死性肉芽肿性肝炎，无恶性迹象。骨髓活检未显示任何异常。结核病评估为阴性。考虑结节病诊断。口服泼尼松治疗使病情完全缓解。
