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.

Clinical Features:

osteolysis_1

  • 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.

Diagnosis:

Biopsy of an additional skin lesion in the area of the medial canthus of the left eye histologically confirmed the diagnosis of sarcoidosis.

Treatment:

  • 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.
Citation
Wiesli et al. Osteolysis of unknown origin: a case report, BMC Oral Health (2015) 15:168

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