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Sarcoidosis-associated acro-osteolysis.

Vishal Patel1, Robert Case2, Saminder Kalra3

  • 1Department of Medicine, Division of Internal Medicine, University of Florida, Gainesville, Florida, USA vishal.patel2@medicine.ufl.edu.

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Sarcoidosis rarely causes acro-osteolysis, a destructive bone condition. This case highlights a unique instance of sarcoid acro-osteolysis affecting the toes, responding to adalimumab therapy.

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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.