Extrapulmonary Sarcoidosis: A Diagnostic Challenge.

Area of Science:

• Rheumatology
• Pulmonology
• Orthopedics

Background:

• Extrapulmonary sarcoidosis is rare, comprising only 2% of all sarcoidosis cases.
• Musculoskeletal involvement in sarcoidosis is exceptionally uncommon.
• Diagnosis typically involves clinical history, imaging, and biopsy confirmation of non-caseating granulomas.

Observation:

• A 26-year-old male presented with right foot pain and unexplained weight loss.
• Magnetic resonance imaging (MRI) revealed bilateral stress fractures in both feet.
• Extensive investigations were conducted to determine the underlying cause.

Findings:

• Sarcoidosis was confirmed via tissue biopsy obtained during bronchoscopy.
• The patient's presentation mimicked other conditions, necessitating a thorough differential diagnosis.
• Non-caseating granulomas were identified, confirming the sarcoidosis diagnosis.

Implications:

• This case underscores the importance of considering sarcoidosis in the differential diagnosis of unexplained musculoskeletal symptoms, even in its rare extrapulmonary forms.
• Early and accurate diagnosis is vital for initiating appropriate treatment, with corticosteroids being a primary therapeutic option.
• Further research into the diverse manifestations of sarcoidosis, particularly its impact on the musculoskeletal system, is warranted.