We have investigated the presence of epithelioid granuloma in the bone marrow of patients with sarcoidosis to evaluate the correlation of the granuloma with hematologic abnormality.
The bone marrow of 22 patients with sarcoidosis, consisting of 7, 13 and 2 patients in stages I, II and III, respectively, was studied. Fourteen of these 22 patients had been treated with corticosteroid at the time of bone marrow examination. Sarcoidosis was diagnosed according to clinical and biopsy findings. Clinically, the three patients with bone marrow involvement had pulmonary fibrosis, extrapulmonary involvement, splenomegaly and prolonged illness.
Nineteen patients underwent bone marrow aspiration and biopsy through the posterior iliac crest; a Jamshidi needle was used for the biopsy. Three patients had only aspiration through the sternum. In three of 19 patients (16%) non-caseating epithelioid granuloma were observed in the biopsied specimens; two of the three patients also showed the granuloma in bone marrow aspirates. Myelogram demonstrated a decrease in nucleated cell counts in 5 patients (23%), decreased neutrophilic series in 4 (18%), an increase in eosinophilic series in 4 (18%), and increased monocytic series in 2 (9%). Peripheral blood showed anemia in 1 patient (5%), neutropenia in 5 (23%), lymphopenia in 6 (27%), monocytosis in 5 (23%) and eosinophilia in 4 (18%). The culture of aspirated bone marrow produced a growth of Propionibacterium acnes in 4 of 17 patients (23%) with sarcoidosis as opposed to 5 of 20 controls (25%) including lung cancer and malignant lymphoma.
In summary, i) granuloma formation in the bone marrow and hematologic abnormality showed no correlation to sarcoidosis; ii) myelograms and the peripheral blood picture did not show a specificity for sarcoidosis; and iii) growth of Propionibacterium acnes in the bone marrow was not significantly related to sarcoidosis.
