A Case of Sarcoidosis with Bone and Bone Marrow Involvement

Introduction: Sarcoidosis is a disease characterized by multisystem involvement, but bone and bone marrow involvement is rare. A case of sarcoidosis with bone marrow involvement is presented. Case Presentation: A 46-year-old woman presented to our outpatient clinic with complaints of fatigue and chest pain in 2016. There was no history of smoking. Chest X-ray showed an infiltration on the left upper zone. Thoracic CT revealed peripheral consolidation of the left lung upper lobe apicoposterior segment, infiltration on right upper lobe and bilateral hilar lymphadenopathies (11 mm). Bronchoscopy was performed with the preliminary diagnoses of tuberculosis and atypical sarcoidosis. Bronchial lavage AFB, mycobacterial culture and cytological examination were normal. BAL lymphocyte ratio was 10% and CD4/CD8 ratio was 2,5. Serum ACE level was normal. Diagnostic transthoracic fine needle aspiration was recommended but the patient refused the procedure and discontinued the follow-up. She was referred to the Hematology Department with a preliminary diagnosis of lymphoma after assessment of PET-CT results by an internal medicine specialist. There was an increase in her complaints in the last 3 months. Hemogram and peripheral smear were normal. In PET-CT, there were hypermetabolic activities in lung, mediastinal and abdominal lymphadenopathies, spleen and bones including right scapula glenoid process, vertebral colon (prominent in C6, C7, T4 and S1 vertebrae), right femur trochanter major, left ischium and both iliac wings. These findings were interpreted in favor of lymphoma. Bone marrow biopsy was performed by Hematology and the pathology result was non-necrotizing granulomatous inflammation. She had been receiving steroid therapy for 2 months with the diagnosis of sarcoidosis. Her clinical and pulmonary radiological findings showed significant regression. Conclusion: Sarcoidosis, a systemic disease, is frequently confused with lymphoma. It should be kept in mind that sarcoidosis may be presented with bone and bone marrow involvement and can be detected incidentally on PET-CT during the diagnosis.