Osseous sarcoidosis presenting as a destructive petrous apex lesion

We report a case of sarcoidosis presenting as a destructive petrous apex lesion of the temporal bone. Sarcoidosis is a disease of unknown etiology, featuring granulomatous inflammation in a number of organs and tissues. Osseous involvement of the temporal bone by sarcoidosis is uncommon and rarely encountered clinically. When osseous tissue is involved, it commonly affects the phalangeal bones of the hands and feet with noncaseating granulomas occupying the marrow space and creating a destructive pattern. A similar clinico-pathologic process was found to occur within the petrous apex of the temporal bone in an individual presenting with otalgia, hearing loss, and aural fullness. Imaging of the temporal bones revealed a unilateral destructive lesion of the petrous apex and adjacent skull base. A review of sarcoidosis and petrous apex lesions is presented. Sarcoid involvement of the petrous apex should be considered in the number of pathologies that feature bony destruction of the petrous apex of the temporal bone.