Extensive Intramuscular Manifestation of Sarcoidosis With Initially Missed Diagnosis and Delayed Therapy

A Case Report

Niklaus Meyer; Reto Sutter; Udo Schirp; Andreas Gutzeit

Disclosures

J Med Case Reports. 2017;11(246) 

In This Article

Background

Sarcoidosis is a multisystem granulomatous disorder, which was first described by Hutchinson in London 1877.[1] Sarcoidosis may involve any organ and clinically presents with diverse manifestations involving accumulation of T lymphocytes, mononuclear phagocytic cells and non-caseating granulomas in a number of organs.[2] In more than 90% of cases, the lungs are involved. Extrapulmonary sarcoidosis, in combination with lung involvement, is found in 30% of patients.[3] The most common sites of extrapulmonary disease include the skin, eyes, exocrine glands, heart, kidneys and central nervous system.[4,5] Extrapulmonary sarcoidosis without lung involvement is very rare.

Secondary musculoskeletal manifestations of sarcoidosis occur in 20% of patients with sarcoidosis and include joint involvement, bone lesions, and muscular disease.[6,7,8,9,10,11] Historically, there have only been two reported cases which describe the isolated sarcoidosis manifestation of muscles, without involvement of the lungs. The first case was in 1961 and the second in 1994.[12,13] In the current case report, we present a clinical situation of isolated muscle sarcoidosis involving the trunk and extremities, but without lung involvement. After initial misinterpretation the sarcoidosis was diagnosed with positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI).

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