Sarcoidosis may affect the bone marrow, causing refractory cytopenias.

Presentations may include:

(1) fever of unknown origin (FUO)

(2) any combination of anemia, leucopenia and thrombocytopenia

(3) diffuse bone marrow uptake on PET scan

(4) incidental finding on a bone marrow examination

(5) workup for metastatic carcinoma or myelodysplasia in an older adult


The diagnosis is considered by the presence of noncaseating granulomas on a bone marrow core biopsy with negative stains for fungi and mycobacteria.


The major problem in diagnosis is exclusion of other causes (infection, drugs, etc). Sarcoid-like reactions may be associated with a variety of neoplasms.


The presence of sarcoid-like findings in other organs (lungs, lymph nodes, etc) can be helpful in establishing the diagnosis.


The diagnosis may be supported by an elevated serum angiotensin-1 converting enzyme (ACE) activity.


One clue to the diagnosis may be an improvement in anemia after starting corticosteroid or immunosuppressive (methrotrexate, mycophenolate mofetil, etc). therapy.


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