Sarcoidosis-associated acro-osteolysis.

Area of Science:

• Rheumatology
• Immunology
• Radiology

Background:

• Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomas.
• Osteoarticular involvement occurs in up to 15% of sarcoidosis patients.
• Acro-osteolysis, distal phalangeal bone destruction, is an exceptionally rare manifestation of sarcoidosis.

Observation:

• A 44-year-old woman with biopsy-proven sarcoidosis presented with digital swelling and pain.
• Radiographs revealed distal phalangeal erosion in the fingers and bone resorption in the toes.
• Finger lesion biopsy confirmed noncaseating granulomas.

Findings:

• The patient was diagnosed with sarcoid acro-osteolysis, a rare condition.
• Treatment with adalimumab led to significant clinical and radiographic improvement.
• This is the first reported case of sarcoid acro-osteolysis involving the toes.

Implications:

• This case expands the known spectrum of sarcoidosis-related osteoarticular manifestations.
• It underscores the potential for progressive and refractory disease even with standard treatments.
• Adalimumab may be an effective therapeutic option for refractory sarcoid acro-osteolysis.