Extensive phalangeal cystic lesions

Abstract

A young black man is presented with a 33-month course of insidious but eventually striking hand deformity and limitation of motion in the absence of any other symptoms. Radiologic and histologic findings of the digits support the diagnosis of sarcoidosis, though physical, laboratory, and chest x-ray examination show no evidence of this multisystem disease.Osseous involvement is a well-recognized feature of sarcoidosis, occurring rarely in the absence of skin lesions or chronic, multiorgan system involvement. When present it is usually not symptomatic. A patient was presented with complaints limited to the hands and feet throughout a 33-month course. The possibility is raised that, in rare instances, sarcoid may be limited to the skeletal system. The patient was well until January 1971 when he noted swelling and mild discomfort in the area of the second left metacarpophalangeal joint, which lasted several days and resolved. This condition recurred soon afterward in several areas of both hands. At all times, swelling was the predominant feature, although there was mild discomfort at times, especially in the morning. He came to the outpatient department at Bellevue Hospital in early 1971 for this complaint. Radiographic examination of the hands showed several cystic bony lesions, but the patient did not return for further workup or treatment. CASE REPORTDuring the next 19 months he noted persistent swelling of the fingers with occasional mild discomfort and morning stiffness. However, he was not greatly bothered and continued his activities as a student, even playing basketball occasionally. He sought no medical attention during this time. I n the summer of 1972, the patient noted that the swelling increased and that he now had difficulty performing certain fine movements because of relatively painless limited motion. When school started in September 1972, he noted he could not hold a pencil properly and sought medical attention for the second time at Bellevue Hospital. Pain was never a major feature and there were no acute at tacks.There was no history of fever, malaise, rash, other musculoskeletal complaints, visual disturbances, cough, or shortness of breath. Past medical history and family history were noncontributory. On admission to Bellevue Hospital in September 1972, physical examination revealed a wellnourished, well-developed black man who appeared healthy, except for obviously swollen, sausage-like fingers. Vital signs, head, eyes, ears, nose, and throat were normal. There were no skin lesions. There were several y2 X v2 cm soft, movable, nontender nodes in both axillae. The chest cage, heart, and lungs were normal. The abdomen showed no organo-