Sarcoidal granulomatous tenosynovitis of the hands occurring in an organ transplant patient

Abstract

Six years after kidney-pancreas transplant, a 47-year-old white man developed multiple subcutaneous and tenosynovial nodules of hands and wrists, limiting mobility. Biopsy of multiple nodules showed fibrosing, sarcoidal granulomas, some of which contained pigmented material. Microbiology, immunohistochemistry, scanning electron microscopy with backscattered electron imaging and energy dispersive X-ray analysis and polymerase chain reaction assays failed to show any infectious agents or foreign material. There was no historical, clinical or laboratory evidence of systemic sarcoidosis. It is not known whether the donor had sarcoidosis. Despite empiric antimycobacterial therapy and ongoing immunosuppressive therapy (corticosteroids, mycophenolate, cyclosporine), the man has progressively developed more nodules, limiting hand function. Sarcoidosis occurring in non-donor tissue post-transplantation is an exceedingly rare complication of transplantation. We discuss this case and review the literature on sarcoidal tenosynovitis and sarcoidosis occurring post-transplantation.

The granulomatous reaction pattern

“…In some cases these lesions may be the first manifestation of sarcoidosis. 125 The etiology of sarcoidosis remains controversial although an infectious origin has long been suspected. 109 Various systemic diseases have been reported in association with cutaneous sarcoidosis.…”

Successful treatment of systemic de novo sarcoidosis with cyclosporine discontinuation and provision of rapamune after liver transplantation

“…Sarcoidosis is a granulomatous disease of unknown aetiology that has rarely been documented after liver transplantation (LT) [1,2]. We herein present a case of systemic, de novo sarcoidosis complicating LT.…”

Rapid Development of Sarcoid Tenosynovitis

“…3,4 In terms of sarcoid tenosynovitis, the tendons of the distal upper extremity are thought to be most commonly involved. 5 Noncaseating granulomas are seen when biopsy is performed on the synovium and tendon sheaths.…”