Resolution of osseous sarcoidosis with steroids

Description

A 56-year-old man with a 10-pack-year history of smoking presented to the clinic with left hip pain. He was treated symptomatically with pain medications. With persistence of symptoms and normal preliminary laboratory results, he underwent MRI of the pelvis which showed lytic lesions suggestive of metastatic disease (figure 1A). Further imaging including CT of the chest revealed bilateral hilar and mediastinal adenopathy along with splenomegaly but no parenchymal lung involvement. Mediastinoscopy with lymph node biopsy showed non-caseating granuloma, and left pubic area biopsy revealed benign bone with epithelioid granuloma, both consistent with sarcoidosis. His pulmonary function tests revealed normal spirometry, lung volume and diffusion. Without any organ dysfunction, he was started on prednisone 40 mg once daily for his hip pain. After 6 months of steroid use, he had significant clinical and radiological improvement (figure 1B). Sarcoidosis is a multisystem disease characterised by the...

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