Clinical images: Subcutaneous elbow and forearm sarcoidosis presenting as olecranon bursitis



Illustration 1.

The patient, a 29-year-old man, was referred to our unit for evaluation of swelling and mild pain in the right elbow and forearm; these symptoms had been present for 3 months. He was initially evaluated by an orthopedic surgeon and was diagnosed as having olecranon bursitis, and he was treated with nonsteroidal antiinflammatory drugs. After 6 weeks of treatment, the swelling increased, progressing halfway up the posterior forearm. He was evaluated by an internist who recommended a skin biopsy, which showed multiple noncaseating granulomas. Staining was negative for acid-fast bacilli and fungi, suggesting sarcoidosis. Magnetic resonance imaging showed an infiltrative process that was replacing the fat signal intensity of the subcutaneous extensor surface with diffuse fluid-like signal (right). A positron emission tomography–computed tomography scan showed increased uptake of 18F-fluorodeoxy glucose (center, left) in the subcutaneous extensor surface and in the mediastinal lymph nodes. There were no associated respiratory symptoms. The patient was treated with standard doses of corticosteroids and low-dose weekly methotrexate, resulting in complete resolution of the clinical features.