A case of sarcoidosis with polyarthritis and marked elevation of blood inflammatory markers

• Published in: NIHON SARUKOIDOSHISU / NIKUGESHUSHIKKAN (The Japanese journal of sarcoidosis and other granulomatous disorders ) Vol. 22; no. 1; pp. 37 - 40
• Main Authors: To, Yasuo, Tai, Ayako, Suzuki, Kenji, Yamaguchi, Masao, Yamamoto, Kazuhiko, Iikura, Motoyasu, Dohi, Makoto, Tanaka, Ryoichi, Nakagome, Kazuyuki, Kawashima, Hidetoshi, Komiya, Akiko, Misaki, Yoshikata
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Sarcoidosis and other Granulomatous Disorders 2002; 日本サルコイドーシス/肉芽腫性疾患学会
• Subjects: Corticosteroid therapy; Polyarthritis; Sarcoidosis; Uveitis; ぶどう膜炎; サルコイドーシス; ステロイド治療; 多関節炎
• ISSN: 1345-0565; 1884-6122
• DOI: 10.14830/jssog1999.22.37

A 63-year-old woman presented with polyarthralgia in her extremities in July 2000. In November, blurred vision occurred. Ophthalmological examinations revealed vitreous snow-ball opacity, retinal vasculitis and macular edema, leading to the diagnosis of uveitis. Based on her ocular findings, sarcoidosis was strongly suspected, and she was admitted to our hospital in December. At the time of hospitalization, she showed polyarthritis in both hands, fingers, shoulders, knees and ankles. Blood analysis showed markedly elevated levels of CRP (8.9mg/dl), ESR (89mm/hr) and γ-globulin (33.6%), but the level of ACE was normal (13.3IU/l). Serum lysozyme level was mildly increased (11.6μg/ml). Rheumatoid factor was not detected in serum. PPD skin test was negative. Chest X-ray and CT showed no lymphadenopathy or lung field abnormalities. However, bronchoalveolar lavage fluid (BALE) analysis revealed increased levels of total cell count (2.2×107), lymphocyte percentage (34.4%) and CD4/8 ratio (8.79). Abnormal 67Ga uptake was observed in the right knee joint. Through these findings, the diagnosis of sarcoidosis was made clinically. Following the administration of prednisolone (30mg/day), her polyarthralgia dissapeared, and both CRP and ESR declined to normal levels. Her ocular findings also improved gradually. Polyarthritis is known to be an infrequent initial manifestation of sarcoidosis; systemic survey including ocular and pulmonary examinations is important for distinguishing sarcoidosis from collagen diseases.