Lab Med Online.  2021 Jul;11(3):194-198. 10.47429/lmo.2021.11.3.194.

Bone Marrow Involvement in Relapsed Sarcoidosis: A Case Report

• Lee J

• KMID: 2526069
• DOI: http://doi.org/10.47429/lmo.2021.11.3.194

Abstract

Sarcoidosis can involve multiple organs and is characterized by non-caseating granuloma on biopsy, which is not pathognomonic of this disease. Therefore, diagnosis requires exclusion of other causes of granuloma, including malignant neoplasm, infections, autoimmune diseases, drug exposure, environmental causes, lymphoma, and tuberculosis. Herein, we present a rare case of a patient with a primary manifestation of sarcoidosis, with typical bilateral hilar adenopathy, and recurrence in the bone marrow. A 50-year-old female patient, who had been diagnosed with sarcoidosis at age 38, was admitted for petechia on both legs and pancytopenia. The patient was concluded to be “highly probable” for sarcoidosis, with at least 90% likelihood, according to the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG) organ assessment instrument. Moreover, the patient had a bone marrow biopsy positive for granulomatous inflammation. Hence, all findings supported the diagnosis of sarcoidosis. Because sarcoidosis is difficult to definitively diagnose, it will be useful to better understand the application, interpretation, and limitations of the WASOG instrument for bone marrow involvement assessment.

Keyword

Bone marrow involvement; Chronic granulomatous diseases; Diagnostic tests; Cytopenia; Extrapulmonary sarcoidosis; Sarcoidosis

Figure

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  Fig. 1 Multiple petechiae on the lower extremities.

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  Fig. 2 Bone marrow biopsy (Hematoxylin and eosin staining) showing (A) multiple non-caseating granulomas (200×) and (B) hypocellularity with cellularity of less than 10% (100×).

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