Vertebral osteonecrosis associated with sarcoidosis. Case report

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Pathology

Background:

• Sarcoidosis is a systemic inflammatory disease typically affecting the lungs, skin, and eyes.
• Osseous involvement in sarcoidosis is uncommon (approx. 5%), usually affecting small bones.
• Spinal sarcoidosis is exceptionally rare, with limited documented cases.

Observation:

• A patient diagnosed with sarcoidosis via lymph node biopsy and spinal involvement presented with progressive L-2 vertebral collapse despite steroid therapy.
• Histological examination of the collapsed L-2 vertebra revealed complete osteonecrosis without typical noncaseating granulomas.
• Infectious diseases, metastatic tumors, and osteoporotic collapse were ruled out through comprehensive laboratory, imaging, and pathological evaluations.

Findings:

• The case demonstrates a rare clinical manifestation of spinal sarcoidosis characterized by extensive vertebral osteonecrosis.
• Complete necrosis of the L-2 vertebra occurred despite intensive conservative management, including steroid therapy.
• The absence of typical sarcoid granulomas complicated the pathological diagnosis, emphasizing osteonecrosis as the primary finding.

Implications:

• This case underscores the diverse and potentially severe skeletal manifestations of sarcoidosis.
• It highlights the diagnostic challenges posed by atypical presentations of spinal sarcoidosis.
• Aggressive surgical intervention, including combined anterior-posterior reconstruction, may be necessary for spinal instability caused by sarcoidosis-induced osteonecrosis.