A case of bone marrow involvement in Sarcoidosis with cresce
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A 63-year-old Japanese man smoked 14 cigarettes a day from the age of 22 to 45, and alcohol daily. He complained of fatigue and weight loss, and had lost 5 kg in weight over the previous 2 months. His condition had gradually deteriorated over the 2 months. It had become difficult for him to move as usual, but he had no obvious neurological disorder.

On examination, severe pancytopenia was detected. He had mild fever and reported appetite loss. High levels of angiotensin-converting enzyme (ACE) and lysozyme suggested sarcoidosis. His medical history included cerebral infarction, aortic valve stenosis, internal carotid artery stenosis, overactive bladder, and hyperlipidemia. Urinalysis revealed mild proteinuria, hematuria, and granular casts.

Abdominal CT showed hepatosplenomegaly and renal enlargement. Immunofluorescence studies were negative for IgG, IgA, IgM, C3, and C1q. Based on these serial findings a diagnosis of sarcoidosis was made. Creatinine rose from 1.1 to 1.76 mg/dL and hematuria worsened. Dose was increased for prednisolone to 50 mg daily, after which renal dysfunction and laboratory data including CRP and lysozyme were improved. Over 90% of patients with sarcoidosis develop lung lesions. The eyes, lymph nodes, and skin are the next most common sites, but any organ can be affected by sarcoidosis. Main cause of death is cardiac involvements.

Bone marrow lesions are very rare, occurring in less than 5% of cases of extrapulmonary sarcoidosis. Renal lesions are occasionally reported in sarcoidosis, with a frequency of about 4-22%. Hypercalciuria, causing glomerular and tubular damage, accounts for half of abnormal renal findings. Proteinuria, nephrotic syndrome, hematuria, and hypertension are common symptoms of glomerular lesions.

The standard treatment for sarcoidosis is Systemic Steroid administration. Prednisolone is indicated at a dose of 20-40 mg/day, and gradually reduced to a maintenance dose of less than 10 mg/day. Immunosuppressants are also considered for intractable cases. We encountered a rare case of bone marrow involvement in renal sarcoidosis. The patient’s condition improved with steroid treatment. It is important to keep in mind that sarcoidosis involves various organs including the bone marrow and kidneys.

source: https://www.sciencedirect.com/science/article/pii/S2213007120304160