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Herniated Lumbar Disk as the Initial Presentation of Sarcoidosis

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Clinical Summary

A 56-year-old woman presented with a 3-month history of progressive lower back pain and paresthesias of the left leg. She had no cough or constitutional symptoms, and her medical history was unremarkable. Physical examination was significant for localized tenderness of the lower back. Magnetic resonance imaging of the spine showed a herniated L4-L5 disk and an abnormal bone marrow signal at the L1 and L4 vertebral bodies (Figure 1A). She underwent an L4-L5 laminectomy with posterolateral fusion

Discussion

Sarcoidosis is a multisystem disorder of an unknown cause characterized by the presence of noncaseating granulomas in the involved tissues. The lymph nodes, lungs, and skin are most commonly involved. Skeletal involvement, often of the hands and feet, is less common and tends to be a late manifestation of the disease.1 Few cases of vertebral involvement have been reported. The diagnosis of vertebral sarcoidosis depends on a compatible clinical presentation, which includes evidence of other

Conclusions

We chose hydroxychloroquine because it has a relatively safe profile and was reported to be effective in a previous case of sarcoid of the talus.7 Our case confirms the relative benefits of a prolonged course of hydroxychloroquine in osseous sarcoidosis.

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Funding: None.

Conflict of Interest: None.

Authorship: All authors had access to the data and played a role in writing this manuscript.

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