Presentation: osteolytic bone lesions, usually multiple, with systemic signs such as fever. The patient may have hypercalcemia. The lesions will be positive on PET scan.
The patient may have a history of sarcoidosis, which may be remote.
The diagnosis involves:
(1) biopsy and culture of an osteolytic lesion
(2) exclusion of malignancy elsewhere
(3) other findings of sarcoidosis present (elevated serum ACE, etc)
(4) clinical improvement after sarcoid-related therapy
In osseous sarcoidosis there will be noncaseating granulomas that are negative for acid-fast bacilli and fungi.
Differential diagnosis:
(1) sarcoid reaction to malignancy
(2) disseminated infection in a patient being treated for sarcoidosis
