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A Rare Presentation of Muscle Involvement in Sarcoidosis: A Case Report

Received: 20 December 2022     Accepted: 11 January 2023     Published: 31 January 2023
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Abstract

Background: Sarcoidosis can affect virtually any organ of the body, primarily the lungs, lymphatic system, skin or eyes, or a combination of these sites and it is characterized by the formation of non-caseating granulomas. Muscular involvement in sarcoidosis is usually asymptomatic or pauci-symptomatic, and its nodular form is exceptional. Observation: In this study, we report the case of a 36-year-old man who had been presenting with nodules in both calves for about two years which onset was progressive. These nodules were painless and deeply embedded in the gastrocnemius muscles. There were no functional complaints, and the general condition was preserved. The physical examination, especially at skin level was free of other clinical signs except the nodules. The PET-scan (positron emission tomography) revealed a few discretely hypermetabolic cervico-axillary lymph nodes and multiple bilateral mediastino-hilar adenopathies involving all lymph nodes, as well as multiple bilateral hypermetabolic pulmonary foci. Biopsy of accessory salivary glands (BASG) exhibited an epithelioid and gigantocellular granuloma without necrosis that confirm the diagnosis of systemic sarcoidosis. The search for another location, notably cardiac, ophthalmological, neurological, or renal, was negative. The respiratory function tests did not show any restrictive syndrome or abnormalities in the DLCO/VA ratio. It was therefore a systemic sarcoidosis with mediastino-pulmonary stage II, diffuse lymph node, splenic, and muscle involvement. Conclusion: This case shows the importance of BASG in the diagnosis of muscular sarcoidosis, in case of impossibility of performing a muscle biopsy.

Published in American Journal of Internal Medicine (Volume 11, Issue 1)
DOI 10.11648/j.ajim.20231101.12
Page(s) 5-7
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Muscular Nodules, PET Scan, Sarcoidosis, Dijon

References
[1] Drent M, Crouser ED, Grunewald J. Challenges of Sarcoidosis and Its Management. N Engl J Med 2021; 385: 1018-1032. DOI: 10.1056/NEJMra2101555.
[2] Arkema, EV, Cozier YC. Epidemiology of Sarcoidosis: Current Findings and Future Directions. Therapeutic Advances in Chronic Disease 2018; 9 (11) 227-240, doi: 10.1177/2040622318790197.
[3] Balageas A, Sanguinet F, Lequen L, Delbrel X. Sarcoïdose musculaire: à propos d’un cas avec atteinte des muscles et des fascias et revue de la littérature. Rev Med Interne 2013; 34: 706-712.
[4] Licharew A. Moskauer venerologische und dermatologische Gesellschaft. Dermatol Zentralbl 1908; 11: 253–254.
[5] Le Roux K, Streichenberger N, Vial C, Petiot P, Feasson L, Bouhour F et al. Granulomatous myositis: a clinical study of thirteen cases. Muscle Nerve 2007; 35: 171–177.
[6] Cohen Aubart F, Abbara S, Maisonobe T, Cottin V, Papo T, Haroche J et al. Symptomatic muscular sarcoidosis. Lessons from a nationwide multicenter study. Neurol Neuroimmunol Neuroinflamm 2018; 5: e452. doi: 10.1212/NXI.0000000000000452.
[7] Sève P, Zénone T, Durieu I, Pillon D, Durand DV. La sarcoïdose musculaire: à propos d’un cas. Rev Med Interne 1997; 18: 984–988.
[8] Wolfe SM, Pinals RS, Aelion JA, Goodman RE. Myopathy in sarcoïdosis: clinical and pathologic study of four cases and review of the literature. Semin Arthritis Rheum 1987; 16: 300–306.
[9] Valeyre D, Sarcoidosis. Support is improving. Rev Prat 2008; 10: 1061–1062.
[10] Silverstein A, Siltzbach LE. Muscle involvement in sarcoïdosis. Arch Neurol 1969; 21: 235–241.
[11] Michon-Pasturel U, Hachulla E, Bloget F, Labalette P, Hatron PY, Devulder B et al. Place de la biopsie de glandes salivaires accessoires dans le syndrome de Löfgren et les autres formes de sarcoïdose. Rev Med lnterne 1996; 17: 452-455.
[12] Baeteman C, Guyot L, Bouvenot J, Chossegros C, Cheynet F, Loudot C et al. Faut-il encore effectuer des biopsies des glandes salivaires accessoires ? Rev Stomatol Chir Maxillofac 2008; 109: 143-147.
[13] Lopes AI, Machado-Neves R, Honavar M, Pereira PR. The role of minor salivary glands’ biopsy in the diagnosis of Sjögren’s syndrome and other systemic diseases. European Journal of Internal Medicine 2021; 94: 69-72. https://doi.org/10.1016/j.ejim.2021.07.012.
[14] Baudin B. L’enzyme de conversion de l’angiotensine I (ECA) dans le diagnostic de la sarcoïdose. Pathol Biol 2005; 53: 183–188.
[15] Londner C, Zendah I, Freynet O, Carton Z, Dion G, Nunes H, et al. Sarcoidosis Treatment. Rev Med Interne 2011; 32: 109–113.
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  • APA Style

    Wanvoegbe, F. A., Turcu, A., Devilliers, H., Bouvet, R., Mouries-Martin, S., et al. (2023). A Rare Presentation of Muscle Involvement in Sarcoidosis: A Case Report. American Journal of Internal Medicine, 11(1), 5-7. https://doi.org/10.11648/j.ajim.20231101.12

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    ACS Style

    Wanvoegbe, F. A.; Turcu, A.; Devilliers, H.; Bouvet, R.; Mouries-Martin, S., et al. A Rare Presentation of Muscle Involvement in Sarcoidosis: A Case Report. Am. J. Intern. Med. 2023, 11(1), 5-7. doi: 10.11648/j.ajim.20231101.12

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    AMA Style

    Wanvoegbe FA, Turcu A, Devilliers H, Bouvet R, Mouries-Martin S, et al. A Rare Presentation of Muscle Involvement in Sarcoidosis: A Case Report. Am J Intern Med. 2023;11(1):5-7. doi: 10.11648/j.ajim.20231101.12

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  • @article{10.11648/j.ajim.20231101.12,
      author = {Finangnon Armand Wanvoegbe and Alin Turcu and Herve Devilliers and Romain Bouvet and Suzanne Mouries-Martin and Geraldine Muller and Marion Laboz and Kouessi Anthelme Agbodande and Angele Azon-Kouanou and Philip Bielefeld and Jean-François Besancenot},
      title = {A Rare Presentation of Muscle Involvement in Sarcoidosis: A Case Report},
      journal = {American Journal of Internal Medicine},
      volume = {11},
      number = {1},
      pages = {5-7},
      doi = {10.11648/j.ajim.20231101.12},
      url = {https://doi.org/10.11648/j.ajim.20231101.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20231101.12},
      abstract = {Background: Sarcoidosis can affect virtually any organ of the body, primarily the lungs, lymphatic system, skin or eyes, or a combination of these sites and it is characterized by the formation of non-caseating granulomas. Muscular involvement in sarcoidosis is usually asymptomatic or pauci-symptomatic, and its nodular form is exceptional. Observation: In this study, we report the case of a 36-year-old man who had been presenting with nodules in both calves for about two years which onset was progressive. These nodules were painless and deeply embedded in the gastrocnemius muscles. There were no functional complaints, and the general condition was preserved. The physical examination, especially at skin level was free of other clinical signs except the nodules. The PET-scan (positron emission tomography) revealed a few discretely hypermetabolic cervico-axillary lymph nodes and multiple bilateral mediastino-hilar adenopathies involving all lymph nodes, as well as multiple bilateral hypermetabolic pulmonary foci. Biopsy of accessory salivary glands (BASG) exhibited an epithelioid and gigantocellular granuloma without necrosis that confirm the diagnosis of systemic sarcoidosis. The search for another location, notably cardiac, ophthalmological, neurological, or renal, was negative. The respiratory function tests did not show any restrictive syndrome or abnormalities in the DLCO/VA ratio. It was therefore a systemic sarcoidosis with mediastino-pulmonary stage II, diffuse lymph node, splenic, and muscle involvement. Conclusion: This case shows the importance of BASG in the diagnosis of muscular sarcoidosis, in case of impossibility of performing a muscle biopsy.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - A Rare Presentation of Muscle Involvement in Sarcoidosis: A Case Report
    AU  - Finangnon Armand Wanvoegbe
    AU  - Alin Turcu
    AU  - Herve Devilliers
    AU  - Romain Bouvet
    AU  - Suzanne Mouries-Martin
    AU  - Geraldine Muller
    AU  - Marion Laboz
    AU  - Kouessi Anthelme Agbodande
    AU  - Angele Azon-Kouanou
    AU  - Philip Bielefeld
    AU  - Jean-François Besancenot
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    DO  - 10.11648/j.ajim.20231101.12
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
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    EP  - 7
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20231101.12
    AB  - Background: Sarcoidosis can affect virtually any organ of the body, primarily the lungs, lymphatic system, skin or eyes, or a combination of these sites and it is characterized by the formation of non-caseating granulomas. Muscular involvement in sarcoidosis is usually asymptomatic or pauci-symptomatic, and its nodular form is exceptional. Observation: In this study, we report the case of a 36-year-old man who had been presenting with nodules in both calves for about two years which onset was progressive. These nodules were painless and deeply embedded in the gastrocnemius muscles. There were no functional complaints, and the general condition was preserved. The physical examination, especially at skin level was free of other clinical signs except the nodules. The PET-scan (positron emission tomography) revealed a few discretely hypermetabolic cervico-axillary lymph nodes and multiple bilateral mediastino-hilar adenopathies involving all lymph nodes, as well as multiple bilateral hypermetabolic pulmonary foci. Biopsy of accessory salivary glands (BASG) exhibited an epithelioid and gigantocellular granuloma without necrosis that confirm the diagnosis of systemic sarcoidosis. The search for another location, notably cardiac, ophthalmological, neurological, or renal, was negative. The respiratory function tests did not show any restrictive syndrome or abnormalities in the DLCO/VA ratio. It was therefore a systemic sarcoidosis with mediastino-pulmonary stage II, diffuse lymph node, splenic, and muscle involvement. Conclusion: This case shows the importance of BASG in the diagnosis of muscular sarcoidosis, in case of impossibility of performing a muscle biopsy.
    VL  - 11
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Author Information
  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France; Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

  • Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin

  • Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

  • Internal Medicine and Systemic Diseases, University Hospital of Dijon Bourgogne, Dijon, France

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