Clinical images: Radiographic healing of osseous sarcoidosis


The patient, a 59-year-old woman, was diagnosed as having osseous sarcoidosis, which was documented by radiography and biopsy. She was treated with prednisone (15 mg/day, tapered to 2 mg/day over 6 months) and methotrexate (MTX) (15 mg/week). Posteroanterior radiographs of the hand were obtained on March 21, 2001 (A) and were compared with radiographs obtained on February 13, 2003 (B) (after 23 months of MTX and 17 months of low-dose prednisone). A, Four sites of involvement, including a lytic lesion (1) on the middle phalanx of the left little finger (arrow 1), and permeative lesions of osseous sarcoidosis (1) on the middle phalanx of the left index finger (arrow 2), the middle phalanx of the right middle finger (arrow 3), and the proximal phalanx of the right little finger (arrow 4). B, Resolution of the permeative lesions and remodeling of the lytic lesion. C and D, Close-up views of the middle phalanx of the left index finger from the radiographs shown in A and B, respectively. There has been one previously reported case of radiographic healing in a patient treated with steroids and chloroquine (2), and another report describes control of the manifestations of osseous sarcoidosis with MTX and hydroxychloroquine treatments, without reference to the fate of the bone lesions (3). This appears to be the first serial radiographic demonstration of healing osseous sarcoidosis.1

Illustration 1.