Isolated Sacral Sarcoidosis a Hidden Cause of Sciatica: Case Report and Brief Review of the Literature
-
Aicha Ben Tekaya
,
Ons Hamdi
,
Leila Rouached
,
Mehdi Bellil
,
Selma Bouden
,
Olfa Saidane
,
Rawdha Tekaya
,
Ines Mahmoud
,
Leila Abdelmoula
Abstract
Bone involvement in sarcoidosis is rare; its estimated prevalence ranges between 3 and 13%. Osseous lesions usually occur in the phalanges of the hands and feet. Involvement of the axial skeleton is more uncommon. Osseous involvement may be asymptomatic. It is often incidentally discovered on imaging modalities. Radiological techniques can reveal sclerotic and/or destructive lesions. We present a case of a 61-year-old woman in whom osseous sarcoidosis of the sacrum was revealed by back pain and sciatica. To our knowledge, only one isolated case of sacral sarcoidosis has been reported in the literature. Sarcoid bone lesions can be present at disease onset without pulmonary involvement. A biopsy is often required in order to eliminate other conditions, especially malignancy. Treatment is not specific and also not needed in a significant number of cases.
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2. Bargagli E, Prasse A. Sarcoidosis: a review for the internist. Intern Emerg Med 2018;13:325‑31.
3. Prior C, Knight RA, Herold M, Ott G, Spiteri MA. Pulmonary sarcoidosis: patterns of cytokine release in vitro. Eur Respir J 1996;9:47‑53.
4. Shorr AF, Murphy FT, Kelly WF, Kaplan KJ, Gilliland WR, Shapeero LG. Osseous sarcoidosis clinical, radiographic, and therapeutic observations. J Clin Rheumatol 1998;4:186‑92.
5. Sparks JA, McSparron JI, Shah N, Aliabadi P, Paulson V, Fanta CH, et al. Osseous sarcoidosis: Clinical characteristics, treatment, and outcomes—Experience from a large, academic hospital. Semin Arthritis Rheum 2014;44:371‑9.
6. Ben Hassine I, Rein C, Comarmond C, Glanowski C, Saidenberg-Kermanac’h N, Meunier B, et al. Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients. Joint Bone Spine 2019;86:789‑93.
7. Wilcox A, Parag B, Sharma P. Bone sarcoidosis. Curr Opin Rheumatol 2000;12:321‑30.
8. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001;164:1885‑9.
9. Bargagli E, Olivieri C, Penza F, Bertelli P, Gonnelli S, Volterrani L, et al. Rare localizations of bone sarcoidosis: two case reports and review of the literature. Rheumatol Int 2011;31:1503‑6.
10. Rockoff S, Rohatgi P. Unusual manifestations of thoracic sarcoidosis. AJR Am J Roentgenol 1985;144:513‑28.
11. Garwood AS, Mikuls TR. A case of isolated sacral and pelvic sarcoidosis diagnosed by bone marrow biopsy. J Clin Rheumatol 2003;9:321‑4.
12. Kuzyshyn H, Feinstein D, Kolasinski SL, Eid H. Osseous sarcoidosis: a case series. Rheumatol Int 2015;35:925‑33.
13. Neville E, Carstairs LS, James DG. Sarcoidosis of bone. Q J Med 1977;46:215‑27.
14. Valencia MP, Deaver PM, Mammarappallil MC. Sarcoidosis of the thoracic and lumbar vertebrae, mimicking metastasis or multifocal osteomyelitis by MRI: case report. Clin Imaging 2009;33:478‑81.
15. Garg S, Garg K, Atalf M, Magaldi J. Refractory vertebral sarcoidosis responding to Infliximab. J Clin Rheumatol 2008;:238‑40.
16. Zener JC, Alpert M, Klainer LM. Vertebral Sarcoidosis. Arch Intern Med 1963;111:696‑702.
17. Goobar JE, Gilmer WS, Carroll DS, Clark GM. Vertebral sarcoidosis. JAMA 1961;178:1162‑3.
18. Rodman T, Funderburk E, Myerson RM. Sarcoidosis with vertebral involvement. Ann Intern Med 1959;50:213‑8.
19. Chandrakumaran A, Bateman HR, Qayyum R. A case report of sarcoidosis mimicking vertebral metastasis. Case Rep Med 2018;2018:5326324.
20. Bloch S, Movson IJ, Seedat YK. Unusual skeletal manifestations in a case of sarcoidosis. Clin Radiol 1968;19:226-8.
21. Stump D, Spock A, Grossman H. Vertebral sarcoidosis in adolescents. Radiology 1976;121:153‑5.
22. Zhou Y, Lower EE, Li H, Farhey Y, Baughman RP. Clinical characteristics of patients with bone sarcoidosis. Semin Arthritis Rheum 2017;47:143-48.
23. Valeyre D, Soler P, Tazi A. Sarcoidose. In: Valeyre D. Maladies et syndromes systémiques. Paris: Flammarion Médecine-Sciences; 2000:1207‑36.
24. Adelaar RS. Sarcoidosis of the upper extremity: Case presentation and literature review. J Hand Surg Am 1983;8:492‑6.
25. Kerdel FA, Moschella SL. Sarcoidosis: An updated review. J Am Acad Dermatol 1984;11:1‑19.
26. Binicier O, Sari I, Sen G, Onen F, Akkoc N, Manisali M, et al. Axial sarcoidosis mimicking radiographic sacroiliitis. Rheumatol Int 2009;29:343‑5.
27. Golzarian J, Matos C, Golstein M, Stallenberg B, Depierreux M, Struyven J. Case report: Osteosclerotic sarcoidosis of spine and pelvis: plain film and magnetic resonance imaging findings. Br J Radiol 1994;67:401-4.
28. Silver HM, Shirkhoda A, Simon DB. Symptomatic osseous sarcoidosis with findings on bone scan. Chest 1987;73:238‑41.
29. Andrès E, Loth F, Orion B, Marcellin L, Durckel J. Iliac bone defects revealing systemic sarcoidosis. Joint Bone Spine. 2001;68:74‑5.
30. Moore SL, Teirstein AE. Musculoskeletal sarcoidosis: Spectrum of appearances at MR Imaging. Radiographics 2003;23:1389‑99.
31. Moore SL, Teirstein A, Golimbu C. MRI of sarcoidosis patients with musculoskeletal symptoms. AJR Am J Roentgenol 2005;185:154‑9.
32. Moore SL, Kransdorf MJ, Schweitzer ME, Murphey MD, Babb JS. Can sarcoidosis and metastatic bone lesions be reliably differentiated on routine MRI? AJR Am J Roentgenol 2012;198:1387-93.
33. Yachoui R, Parker BJ, Nguyen TT. Bone and bone marrow involvement in sarcoidosis. Rheumatol Int 2015;35:1917‑24.
34. Yaghmai I. Radiographic, angiographic and radionuclide manifestations of osseous sarcoidosis. RadioGraphics 1983;375‑96.
35. Browne PM. Bone marrow sarcoidosis. JAMA 1987;240:2654‑5.
36. Yanardağ H, Pamuk GE, Karayel T, Demirci S. Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples. Haematologia (Budap) 2002;32:419‑25.
37. Salmon JH, Perotin JM, Direz G, Brochot P, Laredo JD, Eschard JP. Sarcoïdose vertébrale. Évolution spontanément favorable: une observation et revue de la littérature. Rev Med Interne 2013;34:42‑6.
38. Johnson AK, Johnson JM, Ames E, Filippi C. Spontaneous clinical and radiological resolution of vertebral sarcoidosis: a case report. Spine (Phila Pa 1976) 2012;37:414‑6.
39. Kucharz EJ. Osseous manifestations of sarcoidosis. Reumatologia 2020;58:93‑100.
40. Alawneh D, Al-Shyoukh A, Edrees A. TNF inhibitor treating osseous sarcoidosis and dactylitis: case and literature review. Clin Rheumatol 2020;39:2219‑22.
41. Niederhauser BD, Hohberger LA, Shon W, Howe BM. Osseous sarcoidosis: a case of evolving MR appearances correlating with clinical symptoms. Skeletal Radiol 2014;43:79‑83.
42. Ashamalla M, Koutroumpakis E, McCarthy L, Hegener P, Grimm R, Mehdi S. Osseous sarcoidosis mimicking metastatic cancer on positron emission tomography. J Oncol Pract 2016;12:697‑8.
43. Sakellariou GT, Anastasilakis AD, Karanikolas D, Vounotrypidis P, Berberidis C. Central skeletal sarcoidosis: a case report with sustained remission only on methotrexate, and a literature review on the imaging approach, treatment, and assessment of disease activity. Modern Rheumatol 2013;23:175‑81.
44. Talmi D, Smith S, Mulligan ME. Central skeletal sarcoidosis mimicking metastatic disease. Skeletal Radiol 2008;37:757‑61.
45. Resnik C, Young J, Levine A. Case report 594. Skeletal Radiol 1990;19:79‑81.
46. Cengiz A, Saki H, Yürekli Y. Bone scintigraphy in osseous sarcoidosis. Indian J Nucl Med 2012;27:130-2.
47. Atanes A, Gómez N, de Toro FJ, Freire M, Soler R, Graña J, et al. The bone manifestations in 94 cases of sarcoidosis. An Med Interna 1991;8:481‑6.
48. Kanner C, Libman B, Merchand M, Lemos D. Resolution of osseous sarcoidosis with Methotrexate. Case Rep Rheumatol 2019;2019:4156313
2. Bargagli E, Prasse A. Sarcoidosis: a review for the internist. Intern Emerg Med 2018;13:325‑31.
3. Prior C, Knight RA, Herold M, Ott G, Spiteri MA. Pulmonary sarcoidosis: patterns of cytokine release in vitro. Eur Respir J 1996;9:47‑53.
4. Shorr AF, Murphy FT, Kelly WF, Kaplan KJ, Gilliland WR, Shapeero LG. Osseous sarcoidosis clinical, radiographic, and therapeutic observations. J Clin Rheumatol 1998;4:186‑92.
5. Sparks JA, McSparron JI, Shah N, Aliabadi P, Paulson V, Fanta CH, et al. Osseous sarcoidosis: Clinical characteristics, treatment, and outcomes—Experience from a large, academic hospital. Semin Arthritis Rheum 2014;44:371‑9.
6. Ben Hassine I, Rein C, Comarmond C, Glanowski C, Saidenberg-Kermanac’h N, Meunier B, et al. Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients. Joint Bone Spine 2019;86:789‑93.
7. Wilcox A, Parag B, Sharma P. Bone sarcoidosis. Curr Opin Rheumatol 2000;12:321‑30.
8. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001;164:1885‑9.
9. Bargagli E, Olivieri C, Penza F, Bertelli P, Gonnelli S, Volterrani L, et al. Rare localizations of bone sarcoidosis: two case reports and review of the literature. Rheumatol Int 2011;31:1503‑6.
10. Rockoff S, Rohatgi P. Unusual manifestations of thoracic sarcoidosis. AJR Am J Roentgenol 1985;144:513‑28.
11. Garwood AS, Mikuls TR. A case of isolated sacral and pelvic sarcoidosis diagnosed by bone marrow biopsy. J Clin Rheumatol 2003;9:321‑4.
12. Kuzyshyn H, Feinstein D, Kolasinski SL, Eid H. Osseous sarcoidosis: a case series. Rheumatol Int 2015;35:925‑33.
13. Neville E, Carstairs LS, James DG. Sarcoidosis of bone. Q J Med 1977;46:215‑27.
14. Valencia MP, Deaver PM, Mammarappallil MC. Sarcoidosis of the thoracic and lumbar vertebrae, mimicking metastasis or multifocal osteomyelitis by MRI: case report. Clin Imaging 2009;33:478‑81.
15. Garg S, Garg K, Atalf M, Magaldi J. Refractory vertebral sarcoidosis responding to Infliximab. J Clin Rheumatol 2008;:238‑40.
16. Zener JC, Alpert M, Klainer LM. Vertebral Sarcoidosis. Arch Intern Med 1963;111:696‑702.
17. Goobar JE, Gilmer WS, Carroll DS, Clark GM. Vertebral sarcoidosis. JAMA 1961;178:1162‑3.
18. Rodman T, Funderburk E, Myerson RM. Sarcoidosis with vertebral involvement. Ann Intern Med 1959;50:213‑8.
19. Chandrakumaran A, Bateman HR, Qayyum R. A case report of sarcoidosis mimicking vertebral metastasis. Case Rep Med 2018;2018:5326324.
20. Bloch S, Movson IJ, Seedat YK. Unusual skeletal manifestations in a case of sarcoidosis. Clin Radiol 1968;19:226-8.
21. Stump D, Spock A, Grossman H. Vertebral sarcoidosis in adolescents. Radiology 1976;121:153‑5.
22. Zhou Y, Lower EE, Li H, Farhey Y, Baughman RP. Clinical characteristics of patients with bone sarcoidosis. Semin Arthritis Rheum 2017;47:143-48.
23. Valeyre D, Soler P, Tazi A. Sarcoidose. In: Valeyre D. Maladies et syndromes systémiques. Paris: Flammarion Médecine-Sciences; 2000:1207‑36.
24. Adelaar RS. Sarcoidosis of the upper extremity: Case presentation and literature review. J Hand Surg Am 1983;8:492‑6.
25. Kerdel FA, Moschella SL. Sarcoidosis: An updated review. J Am Acad Dermatol 1984;11:1‑19.
26. Binicier O, Sari I, Sen G, Onen F, Akkoc N, Manisali M, et al. Axial sarcoidosis mimicking radiographic sacroiliitis. Rheumatol Int 2009;29:343‑5.
27. Golzarian J, Matos C, Golstein M, Stallenberg B, Depierreux M, Struyven J. Case report: Osteosclerotic sarcoidosis of spine and pelvis: plain film and magnetic resonance imaging findings. Br J Radiol 1994;67:401-4.
28. Silver HM, Shirkhoda A, Simon DB. Symptomatic osseous sarcoidosis with findings on bone scan. Chest 1987;73:238‑41.
29. Andrès E, Loth F, Orion B, Marcellin L, Durckel J. Iliac bone defects revealing systemic sarcoidosis. Joint Bone Spine. 2001;68:74‑5.
30. Moore SL, Teirstein AE. Musculoskeletal sarcoidosis: Spectrum of appearances at MR Imaging. Radiographics 2003;23:1389‑99.
31. Moore SL, Teirstein A, Golimbu C. MRI of sarcoidosis patients with musculoskeletal symptoms. AJR Am J Roentgenol 2005;185:154‑9.
32. Moore SL, Kransdorf MJ, Schweitzer ME, Murphey MD, Babb JS. Can sarcoidosis and metastatic bone lesions be reliably differentiated on routine MRI? AJR Am J Roentgenol 2012;198:1387-93.
33. Yachoui R, Parker BJ, Nguyen TT. Bone and bone marrow involvement in sarcoidosis. Rheumatol Int 2015;35:1917‑24.
34. Yaghmai I. Radiographic, angiographic and radionuclide manifestations of osseous sarcoidosis. RadioGraphics 1983;375‑96.
35. Browne PM. Bone marrow sarcoidosis. JAMA 1987;240:2654‑5.
36. Yanardağ H, Pamuk GE, Karayel T, Demirci S. Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples. Haematologia (Budap) 2002;32:419‑25.
37. Salmon JH, Perotin JM, Direz G, Brochot P, Laredo JD, Eschard JP. Sarcoïdose vertébrale. Évolution spontanément favorable: une observation et revue de la littérature. Rev Med Interne 2013;34:42‑6.
38. Johnson AK, Johnson JM, Ames E, Filippi C. Spontaneous clinical and radiological resolution of vertebral sarcoidosis: a case report. Spine (Phila Pa 1976) 2012;37:414‑6.
39. Kucharz EJ. Osseous manifestations of sarcoidosis. Reumatologia 2020;58:93‑100.
40. Alawneh D, Al-Shyoukh A, Edrees A. TNF inhibitor treating osseous sarcoidosis and dactylitis: case and literature review. Clin Rheumatol 2020;39:2219‑22.
41. Niederhauser BD, Hohberger LA, Shon W, Howe BM. Osseous sarcoidosis: a case of evolving MR appearances correlating with clinical symptoms. Skeletal Radiol 2014;43:79‑83.
42. Ashamalla M, Koutroumpakis E, McCarthy L, Hegener P, Grimm R, Mehdi S. Osseous sarcoidosis mimicking metastatic cancer on positron emission tomography. J Oncol Pract 2016;12:697‑8.
43. Sakellariou GT, Anastasilakis AD, Karanikolas D, Vounotrypidis P, Berberidis C. Central skeletal sarcoidosis: a case report with sustained remission only on methotrexate, and a literature review on the imaging approach, treatment, and assessment of disease activity. Modern Rheumatol 2013;23:175‑81.
44. Talmi D, Smith S, Mulligan ME. Central skeletal sarcoidosis mimicking metastatic disease. Skeletal Radiol 2008;37:757‑61.
45. Resnik C, Young J, Levine A. Case report 594. Skeletal Radiol 1990;19:79‑81.
46. Cengiz A, Saki H, Yürekli Y. Bone scintigraphy in osseous sarcoidosis. Indian J Nucl Med 2012;27:130-2.
47. Atanes A, Gómez N, de Toro FJ, Freire M, Soler R, Graña J, et al. The bone manifestations in 94 cases of sarcoidosis. An Med Interna 1991;8:481‑6.
48. Kanner C, Libman B, Merchand M, Lemos D. Resolution of osseous sarcoidosis with Methotrexate. Case Rep Rheumatol 2019;2019:4156313
| Files | ||
| Issue | Vol 60, No 3 (2022) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/acta.v60i3.9007 | |
| Keywords | ||
| Osseous sarcoidosis Sarcoidosis Back pain Granuloma Bone marrow biopsy | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ben Tekaya A, Hamdi O, Rouached L, Bellil M, Bouden S, Saidane O, Tekaya R, Mahmoud I, Abdelmoula L. Isolated Sacral Sarcoidosis a Hidden Cause of Sciatica: Case Report and Brief Review of the Literature. Acta Med Iran. 2022;60(3):188-193.
