Sarcoidosis is a systemic granulomatous disease that primarily affects lungs and mediastinal nodes. Extrapulmonary manifestations occur in approximately 50% of the cases and can precede pulmonary involvement. We report the case of a 48-year old Indian woman who presented with umbilical swelling without systemic symptoms. Biopsy revealed well-formed non-caseating granulomas with multinucleated giant cells and special stains for acid fast bacilli and fungi were negative, effectively excluding infectious causes. Lab results revealed increased C-reactive protein (CRP) and angiotensinconverting enzyme (ACE) levels. Whole body 18 F fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/ CT) demonstrated increased uptake in the multiple skeletal muscles including the abdominal wall and myocardium. No pulmonary or mediastinal abnormalities were identified. Sarcoid like reactions related to malignancy or foreign body granulomas were considered less likely in the absence of clinical or histological evidence; thus sarcoidosis was favored This case highlights the uncommon presentation of sarcoidosis and emphasize the role of FDG PET/CT in identifying occult cardiac and muscular disease in clinically silent extrapulmonary sarcoidosis.
Basheer et al. (Thu,) studied this question.