Sarcoidosis is a granulomatous disease that may affect any organ of the body. Localisation of the disease and clinical manifestations are highly variable between affected patients.
- A 74 year old European female patient reported pain in her right lower jaw.
- A panoramic X-ray was performed, presenting an osteolysis of unknown origin in the mandible on both sides, right more than left.
- The patient was then referred to the clinic of cranio-maxillo-facial surgery for further evaluation.
- Pain in the area of the right angle of the mandible for several months; additionally, pain in the right calcaneus and in both forearms has been noted.
- She denied fever and weight loss, but reported cough and dyspnoea on exertion.
- A sicca-symptomatic in both eyes and the oral cavity was present.
- The patient was diagnosed with hypertensive cardiac disease, rhytmogene cardiopathy, hyperlipidaemia, cutaneous psoriasis with psoriasis arthritis, and lumbar vertebral syndrome several years before.
- Tooth 47 showed percussion sensitivity and was not sensitive to cold.
- The radiography showed loosening of cancellous bone with extension of the mandibular canal and partially interrupted cortical bone on the right side.
- Increased bone metabolism in the area of the vertex and the jaw angles of both sides, right more than left was observed.
Biopsy of an additional skin lesion in the area of the medial canthus of the left eye histologically confirmed the diagnosis of sarcoidosis.
- Due to relevant multi-organ disease with symptomatic bone involvement and strong suspicion of neuro-sarcoidosis immunosuppressive therapy with azathioprine was installed.
- The patient was free of pain and the immunosuppressive treatment was well tolerated.