Severe refractory sarcoidosis in a 64-year-old man with persistent leucopenia.
We present a case of bone marrow granulomas in a 64-year-old West Indian man who presented with severe leucopenia, anaemia, thrombocytopenia, hepatosplenomegaly, hypercalcaemia, hypercalciuria, elevated angiotensin converting enzyme level and reticulo-nodular shadows on chest X-ray. Bone marrow biopsy revealed numerous non-caseating epithelioid granulomas. A diagnosis of sarcoidosis was made and he was treated with prednisolone 60 mg daily for four weeks and the dose was subsequently reduced to 30 mg daily. Eight months follow-up revealed persistent pancytopenia. Bone marrow granulomas are rare and, when they occur, sarcoidosis is an uncommon aetiology. This case illustrates that severe leucopenia may occur in sarcoidosis and may present therapeutic difficulties.
Adedayo
A O
AO
Departments of Medicine and Pathology, Princess Margaret Hospital, Ross University School of Medicine, Portsmouth, Dominica, West Indies. oadedayo@hotmail.com
Grell
G A C
GA
Bellot
P
P
D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D001855:Bone Marrow Diseases / Q000175:diagnosis* / Q000473:pathology; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007970:Leukopenia / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000175:diagnosis* / Q000473:pathology; D012720:Severity of Illness Index