Multisystemic sarcoidosis-important lessons learnt from one of the great imitators

Area of Science:

• Rheumatology
• Oncology
• Immunology

Background:

• A patient presented with symptoms initially diagnosed as psoriatic arthropathy, including acute anterior uveitis, psoriasiform rashes, and polyarthritis.
• Subsequent development of back and abdominal pain led to imaging revealing hilar lymphadenopathy, liver hypodensities, and bone lesions, raising suspicion of metastatic malignancy.

Observation:

• The patient's initial presentation included ocular, skin, and joint inflammation.
• Further investigations, including a liver biopsy, were essential for re-evaluation.
• Imaging demonstrated involvement of the lymph nodes, liver, and skeletal system.

Findings:

• A diagnosis of multisystemic sarcoidosis was established, involving ocular, reticuloendothelial, hepatic, and skeletal systems.
• Treatment with systemic glucocorticoids and immunosuppressants led to significant clinical improvement.
• Imaging confirmed resolution of liver granulomata and reduction in back pain.

Implications:

• This case underscores the importance of a comprehensive clinical assessment and open-minded evaluation in diagnosing complex conditions.
• It highlights the diagnostic challenge posed by sarcoidosis, which can mimic metastatic malignancy.
• Timely and accurate diagnosis of multisystemic sarcoidosis is critical for appropriate management and patient prognosis.