Sarcoidosis associated with myositis-type myopathy: A case report

Abstract

    The patient was a 59-year-old woman with a history of uveitis since 2004. In September, 2008, a rash emerged on her lower extremities, which necessitated a skin biopsy in January of the following year. Examination of the biopsy specimen revealed non-caseous epithelioid granulomas with multinucleated giant cells characteristic of sarcoidosis. She had malaise as well as discomfort in her lower extremities starting in March, 2009, and so was referred to our department in August. A physical examination revealed neither muscle weakness nor tenderness. Blood studies showed an elevated erythrocyte sedimentation rate and mild increases in myogenic and angiotensin converting enzymes. T2-weighted and STIR MR images showed a large region of highintensity signals with ambiguously defined borders in the thigh muscle, raising the suspicion of myositis. Biopsy of the same muscle disclosed degenerated muscle fibers, inter-muscle fiber infiltration of inflammatory cells, and granulomas in some areas, establishing a diagnosis of sarcoid myopathy. Immunostaining demonstrated that the majority of inflammatory cells were CD4-positive T lymphocytes, a finding compatible with sarcoidosis. Prednisolone at a dose of 25 mg/day gave the patient relief from her clinical symptoms.