Sarcoidosis with bone marrow involvement

Abstract

427virus, hepatitis B virus, hepatitis C virus, cytomegalovirus, and Epstein-Barr virus) were excluded. Blood and urine cultures were negative. Tuberculosis was excluded. Serum iron and folic acid levels were normal, while a moderate vitamin B 12 deficiency was detected (101 pg/ml; normal range, 157-1057 pg/ml). A small proportion of erythroblasts had dysplastic features on bone marrow (BM) aspiration, which might be consistent with vitamin B 12 deficiency; however, an early phase of myelodysplastic syndrome was also considered. Thus, a trephine biopsy was performed. Considering the results of the BM biopsy, the patient received vitamin B 12 injections at a dose of 0.1 mg daily intramuscularly, then once a week for a total of 2 months, but pancytopenia persisted. The biopsy did not reveal any potential causes of pancytopenia, and no dysplastic features were demonstrated. Nevertheless, an oval sarcoidal granuloma consisting of epithelioid histiocytes and multinucleate giant cells was observed in the hematoxylin and eosin stain of the biopsy. The granuloma was sparsely surrounded by a rim of lymphocytes. Necrosis was not observed (FIGURE 1). Finally, the patient was diagnosed with disseminated sarcoidosis and hypersplenism, which seemed to be the most likely cause of pancytopenia.A 46-year-old man was diagnosed with stage I sarcoidosis in 2010, but he did not agree to further follow-up visits and investigations. He remained free of any disease symptoms until 2014 when progressive weakness and dyspnea occurred. Chest X-ray and high-resolution computed tomography scans showed bilateral hilar adenopathy and numerous subpleural reticular opacities-the manifestations consistent with stage II sarcoidosis. Surprisingly, the complete blood count (CBC) test revealed pancytopenia with a neutrophil count of 1.1 × 10 9 /l, hemoglobin concentration of 10.5 g/dl, and platelet count of 3 × 10 9 /l. The patient was transfused with platelet concentrates and then referred to the Hematology Unit. On admission, his overall condition was good and an abdominal ultrasound showed hepatomegaly (anteroposterior [AP], 16 cm) and massive splenomegaly (AP, 20 cm). No other abnormalities were detected. He remained pancytopenic on the CBC test, but differential leucocyte counts were normal. Biochemical test results were within normal ranges except for the serum β 2 microglobulin concentration, which was markedly elevated to 8.27 mg/l (normal range, 1.5-3.0 mg/l). Protein levels, including immunoglobulin (Ig) G, IgA, and IgM concentrations, as well as electrophoresis were normal. Hemolysis and viral infections (human immunodeficiency

Isolated bone marrow sarcoidosis presenting as fever of unknown origin in a case of chronic myeloid leukemia

“…Leukopenia may be the only initial presentation which may be either due to bone marrow infiltration or hypersplenism and lymphocyte redistribution [8,9]. Bone marrow sarcoidosis can even present with cytopenias [8,9]. One patient had mild anemia and mild leukopenia.…”

“…The commonest hematological abnormality in sarcoidosis (with or without bone marrow involvement) is anemia which may be either iron deficiency anemia or hemolytic anemia or anemia of chronic disease [7]. Leukopenia may be the only initial presentation which may be either due to bone marrow infiltration or hypersplenism and lymphocyte redistribution [8,9]. Bone marrow sarcoidosis can even present with cytopenias [8,9].…”

Bone marrow involvement in sarcoidosis: an elusive extrapulmonary manifestation

“…A stepwise approach for diagnosis of cytopenias in sarcoidosis has been suggested (Figure 3). In the absence of hematologic derangements, establishing the diagnosis of BMS becomes challenging [37]. Our patient had anemia and leukopenia due to a combination of BM involvement and hypersplenism.…”