Bilateral swelling of the forearms revealing muscular sarcoidosis: a case-based review

Abstract

Muscular sarcoidosis is rarely symptomatic and mainly affects proximal muscles of the lower extremities. However, the distal localization in the upper extremities is rare. We used systematic approach to analyze all relevant literature review and we identified only three cases of muscular sarcoidosis of the upper extremities. We report the case of a 56-year-old woman who presented distal and bilateral swelling of the extensor surface of the forearms revealing muscular sarcoidosis. The laboratory exams associated elevated acute phase reactants with elevated serum angiotensin-converting enzyme levels and normal serum muscle enzymes. Ultrasound and MRI showed a bilateral and symmetrical muscle hypertrophy of the extensors of the fingers. Histological examination of muscle specimen and minor salivary gland biopsy revealed noncaseating epithelioid-cell granulomas. Therefore, the diagnosis of muscular sarcoidosis of the finger extensor muscles was made. Swelling of the forearms disappeared gradually under prednisolone 1 mg/kg/day. We used methotrexate as a steroid-sparing agent. Muscular MRI in sarcoidosis is not specific, but is to make a diagnosis of the lesion to optimize the biopsy which the cornerstone of the diagnosis ofsarcoidosis.

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References

  1. 1.

    Bechman K, Christidis D, Walsh S, Birring SS, Galloway J (2018) A review of the musculoskeletal manifestations of sarcoidosis. Rheumatology (Oxford) 57:777–783. https://doi.org/10.1093/rheumatology/kex317

    Article  Google Scholar 

  2. 2.

    Sazliyana Shaharir S, Jamil A, Kosasih S, Soo Fin L, Sridharan R, Hayati Md Pauzi S (2017) Sarcoid myopathy mimicking polymyositis: a case report and pool analysis of the literature reviews. Acta Med Iran 55:800–806

    PubMed  Google Scholar 

  3. 3.

    Balageas A, Sanguinet F, Lequen L, Delbrel X (2013) Muscular sarcoidosis: a case report of muscle and fascia involvement and literature. La Rev Med 34:706–712. https://doi.org/10.1016/j.revmed.2013.02.008

    CAS  Article  Google Scholar 

  4. 4.

    Gaulke R, Suppelna G (2003) Solitary tumorous muscular sarcoidosis (granulomatous myopathy) of the forearm extensors. Z Rheumatol 62:66–72. https://doi.org/10.1007/s00393-003-0411-4

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Ikeda K, Saito M, Sueyoshi Y, Ichizen H, Tomita K (1996) Flexion contracture of fingers due to sarcoidosis-a case report. Acta Orthop Scand 67:623–625. https://doi.org/10.3109/17453679608997770

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Yamaguchi N, Hosoda S, Bamba T et al (1972) A case of sarcoidosis of the skeletal muscle. Tumor formation in the right upper arm. Nihon Naika Gakkai Zasshi 61:643–648. https://doi.org/10.2169/naika.61.643

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Iannuzzi MC, Rybicki BA, Teirstein AS (2007) Sarcoidosis. N Engl J Med 357:2153–2165. https://doi.org/10.1056/NEJMra071714

    CAS  Article  Google Scholar 

  8. 8.

    Brandão Guimarães J, Nico MA, Omond AG, Silva FD, Aivazoglou LU, Carneiro BC, Fernandes ARC (2019) Radiologic manifestations of musculoskeletal sarcoidosis. Curr Rheumatol Rep 21:7. https://doi.org/10.1007/s11926-019-0806-0

    Article  PubMed  Google Scholar 

  9. 9.

    Charlot-Lambrecht I, Brochot P, Noblet H, Varoquier C, Eschard JP (2009) Neurogenic muscle hypertrophy. Jt Bone Spine 76:401–403. https://doi.org/10.1016/j.jbspin.2008.10.014

    Article  Google Scholar 

  10. 10.

    Sindoni A, Rodolico C, Pappalardo MA, Portaro S, Benvenga S (2016) Hypothyroid myopathy: a peculiar clinical presentation of thyroid failure. Review of the literature. Rev Endocr Metab Disord 17:499–519. https://doi.org/10.1007/s11154-016-9357-0

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Zeng Y, Liu Y, Xie Y, Liang J, Kuang J, Lu Z, Zhou Y (2019) Muscular tuberculosis: a new case and a review of the literature. Front Neurol 10:1031

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Lee S, Lee IS, Mok J, Song YS, Choi KU (2018) Muscular sarcoidosis involving the chest and abdominal walls: case report with MR imaging. Skelet Radiol 47:407–411. https://doi.org/10.1007/s00256-017-2787-2

    Article  Google Scholar 

  13. 13.

    Akasbi N, Tahiri L, Daoudi A et al (2011) Frohse’s arcade syndrome revealing sarcoidosic myopathy. Jt Bone Spine 78:522–523. https://doi.org/10.1016/j.jbspin.2011.03.007

    Article  Google Scholar 

  14. 14.

    Barnard J, Newman LS (2001) Sarcoidosis: immunology, rheumatic involvement, and therapeutics. Curr Opin Rheumatol 13:84–91. https://doi.org/10.1097/00002281-200101000-00014

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Amber KT, Bloom R, Mrowietz U, Hertl M (2015) TNF-α: a treatment target or cause of sarcoidosis? J Eur Acad Dermatol Venereol 29:2104–2111. https://doi.org/10.1111/jdv.13246

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Baughman RP, Winget DB, Lower EE (2000) Methotrexate is steroid sparing in acute sarcoidosis: results of a double blind, randomized trial. Sarcoidosis, Vasc Diffus lung Dis Off J WASOG 17:60–66

    CAS  Google Scholar 

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Correspondence to Mohamed Ahmed Ghassem.

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Ahmed Ghassem, M., El Maghraoui, A., Djossou, J.H. et al. Bilateral swelling of the forearms revealing muscular sarcoidosis: a case-based review. Clin Rheumatol (2020). https://doi.org/10.1007/s10067-020-05259-1

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Keywords

  • Magnetic resonance imaging
  • Muscular diseases
  • Sarcoidosis
  • Upper extremities