Sarcoidosis is characterised by the formation of noncaseating
granulomas classically affecting lungs, lymph nodes and skin. Osteoarticular involvement affects up to 15% of patients; however,
acro-osteolysis, destruction involving distal phalanges of fingers and toes, associated with
sarcoidosis, is extremely rare. A 44-year-old woman with a history of biopsy-proven
sarcoidosis managed with
prednisone and
methotrexate presented with swelling and
pain in the distal fingers of her right hand without
skin manifestations. Radiographic imaging showed erosion of distal phalanges on second, third and fifth fingers and
bone resorption in bilateral toes. A biopsy of the finger lesions showed noncaseating
granulomas consistent with
sarcoidosis. She was diagnosed with sarcoid
acro-osteolysis and started on
adalimumab with clinical and radiographic improvement. While most cases of osteoarticular
sarcoidosis are asymptomatic and respond to standard immunosuppression, we present a case with progressive and refractory
clinical course. This is the first reported case of sarcoid
acro-osteolysis affecting the toes.