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48 year old male presents with pain in fingers of both hands. He has a 25 year history of sarcoidosis diagnosed via epitrochlear lymph node biopsy in 1982. The patient has a questionable history of lung involvement as demonstrated by nonspecific spirometry changes with normal chest radiography, which is confused by his history of chronic bronchitis. The patient has suffered joint (shoulder, ankle, and knee) pain and skin symptoms for several years.
Vital signs WNL
Hands: Swelling of proximal interphalangeal joints of both hands without tenderness, warmth, or erythema
Skin: plaque-like thickening and areas of hyper and hypopigmentation of the skin of upper arms, upper back, neck and scalp.
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Bilateral radiographs of the hands in the â€œCatcherâ€™s or Norgaard view show abnormalities of the left hand including osteopenia with lacy reticulation of phalanges of the fifth finger
Osseous SarcoidosisDiagnosis Confirmed by: Imaging coupled with biopsy confirmed sarcoidosis
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Tx and Followup:Bone involvement is difficult to treat separate from overall disease. Vitamin D and calcium supplementation may increase already elevated risk of hypercalcemia in sarcoid patients. Systemic treatment for sarcoidosis (corticosteroids, methotrexate, etc.) may slow or even reverse bone damage. Serial radiography of involved bones may be used to evaluate overall rogression of disease and provides non-invasive modality to assess efficacy of therapeutic interventions.
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This is not a "Case of the Week"MedPix™ COW Cases are eligible for Category 1 CME and CNE
MedPix™ COW Cases are eligible for Category 1 CME and CNE
The Department of Radiology and Radiological Sciences
Uniformed Services University
Bethesda, Maryland 20814.