Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas. Thoracic involvement is the most common site of the disease, observed in approximately 90% of cases. Extra-thoracic involvement occurs in 50%, but bone involvement remains rare (3–13%). There is no codified therapeutic management.
Case 1: A 30-year-old woman presented with dyspnea and fever. Imaging revealed mediastinal adenomegaly and a lytic femoral neck lesion. Biopsies confirmed granulomatous disease, leading to a diagnóstico of type 2 medullary-pulmonary sarcoidosis with bone involvement. She was treated with corticosteroids and required surgical intervention due to a fracture risk.
Case 2: A 57-year-old woman with systemic sarcoidosis experienced relapse after corticosteroid treatment, presenting with new osteolytic lesions and lymphadenopathy. Biopsy confirmed osseous sarcoidosis. High-dose corticosteroids, combined with methotrexate, led to significant clinical improvement and stabilization of lytic lesions on imaging.
Skeletal lesions are rare and can mimic malignancies. Diagnosis requires histological confirmation. Treatment primarily involves corticosteroids, and it may necessitate further immunosuppressive strategies.
