Abstract
Sarcoidosis is a multisystem syndrome characterized by the development of non-caseating granulomata. The lesion disrupts the architecture and function of the tissue in which they reside.
Sarcoidosis in and around the spine is very rare affecting less than 1% of patients with the disease. It can affect various parts of the craniospinal axis: intramedullary, intradural, extramedullary, intraspinal epidural spaces and in vertebral bodies. In this report we present a rare case of sarcoidosis in the intervertebral disc causing diagnostic dilemma. To our knowledge this has never been reported before.
Our patient has had aggressive systemic sracoidosis, however the first presentation of the disease was in his spine in the form of intractable low back and leg pain resistant to treatment. X-ray and MRI showed Listhesis at L4/5. Posterior Fusion was performed. Pain became worse and accordingly anterior fusion was attempted, which was aborted because of excessive bleeding. Patient then developed subcutaneous nodules. Biopsy from the nodules showed features of non-caseating granulomatous lesion. In view of the persistence of his symptoms biopsy from L4/5 disc was performed and showed similar histological features. CT chest and abdomen confirmed the diagnosis of sarcoidosis. The patient was commenced on steroids and Methotrexate.
In this report we highlight the approach to diagnosis and management and present a review of the literature. Our main aim is to make the clinicians more aware of this rare condition and raise the index of suspicion, particularly if the first presentation of this multi-system granulomatous disorder is in the spine.
Correspondence should be addressed to Mr J. O’Dowd, Honorary Secretary at SBPR c/o BOA, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE.
