Doctors should therefore consider this clinical sign to support early diagnosis and prevent further complications.

The study, “Bone Marrow Involvement in Sarcoidosis: An Elusive Extrapulmonary Manifestation,” was published in the Journal of Community Hospital Internal Medicine Perspectives.

Sarcoidosis can affect many organs and therefore has multiple manifestations, making diagnosis difficult. In more than 90% of cases, the disease affects the lungs, but it can also involve the liver, heart, intestines and bones.

In approximately 10% of cases, sarcoidosis affects the bone marrow, changing the numbers of different blood cells and causing symptoms such as an enlarged spleen, weight loss, fever and fatigue.

The researchers reported the case of a 51-year-old African-American woman previously diagnosed with cutaneous sarcoidosis that later affected the bone marrow and lungs.

The patient came to hospital after experiencing burning below the knee for two weeks. She also had a low-grade fever, a chronic dry cough and reduced appetite, and had unintentionally lost 30 pounds over the previous two years. Her vital signs were normal.

Laboratory tests showed reduced white- and red-blood-cell counts, iron deficiency, borderline anaemia, increased inflammatory blood cells and elevated inflammatory markers such as C-reactive protein.

Physical examination and imaging tests showed a lung nodule, abnormally sized lymph nodes, and an enlarged liver and spleen. These findings suggested that sarcoidosis, initially limited to the skin, had progressed to other organs.

The diagnosis was confirmed when doctors identified granulomas—clusters of inflammatory cells characteristic of sarcoidosis—in biopsies of the patient’s lungs and bone marrow. The team also looked for signs of sarcoidosis in the nervous system but found none.

The patient was then treated with oral prednisone, a corticosteroid that reduces inflammation and suppresses the immune system.

“To our knowledge, there are no randomised controlled trials comparing different treatment strategies for bone-marrow sarcoidosis. Prednisone remains the mainstay of treatment,” the team stated.

Based on this case report, the researchers emphasised the importance of monitoring sarcoidosis progression and looking for secondary symptoms. In this case, insufficient monitoring may have allowed the disease to spread from the skin to other organs.

According to the team, bone-marrow sarcoidosis “represents a rare manifestation of extrapulmonary sarcoidosis and is more prevalent in women and African-Americans. Unexplained cytopenias [changes in blood-cell counts], although nonspecific, may be the only finding; clinicians should therefore maintain a high index of suspicion.”

Source: https://sarcoidosisnews.com/news/blood-cell-count-abnormalities-might-indicate-bone-marrow-involvement-in-sarcoidosis-report-suggests/