Osseous sarcoidosis with lupus pernio: an interesting case r
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A 60 yr old woman presented with an 18-month history of purple discolouration and painless swelling of the right index finger, right second toe and bridge of nose. Physical examination revealed a violaceous indurated plaque on the bridge of nose, along with dactylitis of the involved digits, with no fingernail changes.

Radiographs showed osteolytic lesions in the phalanges with a reticular pattern and hilar lymph node enlargement. Serum angiotensin-converting enzyme levels were elevated (69 U/l, normal 8-52 U/l) while thoracoabdominal computed tomography scan showed mediastinal, hilar and abdominal lymphadenopathy. There was no clinical or laboratory evidence of multiple myeloma.

Biopsy from the skin and bone lesions showed non-necrotizing granulomas containing giant cells, with no evidence of mycobacterial or fungal infection. A diagnosis of lupus pernio with osseous sarcoidosis was made. The patient was treated with prednisolone (1 mg/kg) for two weeks with tapering to 10 mg/day over six weeks, hydroxychloroquine (400 mg/day) and topical mometasone ointment for two months. At follow up after four days, the lesions demonstrated partial resolution.

Key takeaways:-
-Osseous sarcoidosis occurs usually in patients with multivisceral involvement and has a predilection for small bones of the hand and feet.

- Skeletal lesions are often associated with cutaneous manifestations, most commonly lupus pernio, as in this patient.

- Differentials such as skeletal metastases, multiple myeloma and chronic osteomyelitis should be considered and ruled out before the treatment.

- Non-steroidal anti-inflammatory drugs, corticosteroids and hydroxychloroquine are the mainstay of therapy.

Source: https://pxmd.co/jdAC1
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