title: Osseous sarcoid with lytic lesions in skull.
abstract: Sarcoidosis bone is uncommon, and involvement of the skull is exceptionally rare. We present a 65-year-old obese female who presented with a 2-month history of dryness of mouth, polyuria, fatigue, and anorexia. She had generalized lymphadenopathy, organomegaly, and hypercalcemia, and a skeletal survey revealed extensive osteolytic lesions in the skull and phalanges. Both lymph node biopsy from the cervical lymph node and bone marrow examination revealed non-caseating granulomas, suggesting sarcoidosis. She was started on 1 mg/kg oral corticosteroids; during a follow-up of 6 months, she achieved normocalcemia; however, the punched-out lesions in the skull remained unchanged. This case reiterates several important issues that all lymphadenopathy in emerging nations may not be tubercular, and presence of osteolytic lesions in skull are unusual for sarcoid, at an elderly age, necessitates evaluation for more common etiologies like metastases and myeloma. Finally, patients with osseous sarcoid should be on a close follow-up since due to the rarity of this presentation, no definite consensus on the management of such cases exists in the literature.
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India, surivikas9479@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Suri
authors.forename: Abhijai
authors.initials: A
authors.lastname: Singh
authors.forename: Reena
authors.initials: R
authors.lastname: Das
authors.forename: Ashim
authors.initials: A
authors.lastname: Das
authors.forename: P
authors.initials: P
authors.lastname: Malhotra
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.forename: S
authors.initials: S
authors.lastname: Kumari
authors.forename: N
authors.initials: N
authors.lastname: Khandelwal
authors.forename: S
authors.initials: S
authors.lastname: Varma
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D001847:Bone Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010014:Osteolysis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011237:Predictive Value of Tests; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D012886:Skull / Q000187:drug effects / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones