Diffuse Lung Disease: Fellow Case Report Poster - Diffuse Lung Disease II |

A Case of Spinal Sarcoidosis FREE TO VIEW

Carlos Martinez-Balzano, MD; William Wong, DO; Andres Sosa, MD; Karl Uy, MD; Paulo Oliveira, MD
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University of Massachusetts Medical School, Division of Lung, Allergy and Critical Care Medicine, Worcester, MA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):503A. doi:10.1016/j.chest.2016.08.517
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SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoidosis is a granulomatous disease that can affect any organ. However, osseous sarcoidosis (OS) is thought to be rare.

CASE PRESENTATION: A 65-year-old woman with history of smoking had a spine MRI with gadolinium contrast for new-onset severe back pain. She had no other complaints and her physical examination was unremarkable. The MRI showed hypointense lesions in T1, T2, T5, T6, L3 and L4, concerning for metastatic malignancy. This prompted the acquisition of a CT of the chest, abdomen and pelvis which revealed extensive bilateral mediastinal and pulmonary lymphadenopathies, found to be FDG-avid (all with SUV >6) on a subsequent PET scan. The bone lesions did not have increased metabolic activity except for a new right scapular lesion (SUV 6.3). The patient underwent a bronchoscopy with EBUS-guided fine needle aspiration of lymph nodes (LN) 4R, 7 and 12R. Cytology specimens returned with non-necrotizing granulomas (NNGs) and no malignant cells. There was concern for a neoplasia-related granulomatous reaction and the patient was referred to thoracic surgery for an excisional biopsy. She had a mediastinoscopy with excision of anthracotic LNs 3 and 4R. Final pathology showed NNGs with negative bacterial and fungal cultures. In light of this evidence, the patient was diagnosed with sarcoidosis with spinal lytic lesions. Therapy with glucocorticoids is planned to begin soon.

DISCUSSION: OS has been reported to occur in 0.5-13% of cases, but this frequency may be higher since not all patients are symptomatic. In particular, spinal sarcoidosis appears rare with only small series of cases published. Lesions in OS can be permeative, sclerotic, or lytic, among other radiographic patterns. A study of 20 patients with OS found that it is difficult to differentiate these lesions from mestastatic cancer, such as in our case, especially when they are in the spine and are diagnosed by MRI or PET-CT. Spinal sarcoidosis has been described to have both mild and increased FDG-uptake on PET-CT. Treatment of vertebral sarcoidosis is not standardized but most clinicians report using glucocorticoids for symptomatic cases, while reserving close observation for asymptomatic patients.

CONCLUSIONS: OS can present with multiple lytic vertebral lesions on MRI and should be considered in their differential diagnosis, along with metastatic malignancy.

Reference #1: Sparks JA, et al. Osseous sarcoidosis: clinical characteristics, treatment, and outcomes--experience from a large, academic hospital. Semin Arthritis Rheum. 2014;44:371-9.

DISCLOSURE: The following authors have nothing to disclose: Carlos Martinez-Balzano, William Wong, Andres Sosa, Karl Uy, Paulo Oliveira

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