Sarcoid Myofasciitis

Abstract

positively coupled to adenylyl cyclase in embryonic bovine tracheal (EBTr) cells: pharmacological characterization using agonists and antagonists. Br J Pharmacol 1999;127:204-10. 48. Tesch AM, MacDonald MH, Kollias-Baker C, Benton HP.Chondrocytes respond to adenosine via A 2 receptors and activity is potentiated by an adenosine deaminase inhibitor and a phosphodiesterase inhibitor. Osteoarthritis Cartilage 2002;10: 34-43. 49. Attur M, Al-Mussawir HE, Patel J, Kitay A, Dave M, Palmer G, et al. Prostaglandin E2 exerts catabolic effects in osteoarthritis cartilage: evidence for signaling via the EP4 receptor. The patient, a 56-year-old woman with a 2-year history of untreated stable pulmonary sarcoidosis, was admitted for evaluation of bilateral leg edema without muscle weakness or myalgia. Laboratory tests showed elevated levels of C-reactive protein (3.18 mg/dl [normal ,0.3]), aldolase (13.2 units/liter [normal 2.7-7.5]), and angiotensin-converting enzyme (47.0 IU/liter [normal 7.7-29.4]). Her creatine phosphokinase level was normal. Fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed diffuse FDG uptake in all muscle groups ( A and B). Magnetic resonance imaging (MRI) of the thighs showed diffuse enhancement of the fascia and muscle (C; T2-weighted image with contrast). Muscle biopsy of the right quadriceps revealed noncaseating granulomas in the endomysium and fascia (D), confirming the diagnosis of sarcoid myofasciitis. Corticosteroid treatment was initiated, and the patient's symptoms disappeared within 1 month. Fasciitis in sarcoidosis is a rarely reported condition and can be missed in diagnosis due to normal muscle enzyme levels. Imaging studies such as FDG-PET or MRI should be considered in cases of unexplainable swelling or myalgia in patients with sarcoidosis.