Obinwanne F.C. Ugwonali MD, May Parisien MD, Katherine G. Nickerson MD, Brian Scully MD, Sasha Ristic MD and Robert J. Strauch MD
Departments of Orthopaedic Surgery, Pathology, and Medicine, Columbia-Presbyterian Medical Center, Columbia University, New York, NY.
A destructive granulomatous process involving the right fifth metacarpal and the soft tissues of the right thumb and nose of an African-American woman without pulmonary disease is described. The initial biopsy examination of the metacarpal showed caseating and noncaseating granulomata. After a fifth-ray amputation the disease progressed, leading to the referral of the patient to our institution. A biopsy examination of this recurrence showed a predominance of solid noncaseating granulomata. The diagnosis of sarcoidosis was made on the basis of the morphology of the granulomata and by exclusion of infectious and neoplastic causes. Steroid therapy has resulted in cessation of clinical and radiographic disease progression at a 3-year clinical follow-up evaluation.
Key words: Caseating granuloma; noncaseating granuloma; osseous sarcoidosis; sarcoidosis