Case presentation
A 48-year-old female noticed a subcutaneous nodule. She presented with
remittent fever, fatigue, weight loss, and abdominal pain. Laboratory
tests showed elevated levels of lysozyme, soluble interleukin-2
receptor, and angiotensin-converting enzyme. Computed tomography (CT)
revealed pulmonary reticular opacities, hepatomegaly, and massive
splenomegaly. Fluorodeoxyglucose position emission tomography (FDG
PET)/CT showed FDG uptake not only in the liver, spleen, and systemic
lymph nodes, but also in the humerus, scapula, the 4–7th thoracic
vertebrae, pelvis, and femur (Figure 1, 2). Histological samples from
the skin, liver, and bone marrow biopsies exhibited noncaseating
granulomas with epithelioid cells, which were diagnosed as multiorgan
sarcoidosis.
Sarcoidosis is a systemic inflammatory disease of unknown etiology
characterized by the formation of noncaseating granulomas in the
affected organs. Although FDG PET/CT is not included in the standard
workup for sarcoidosis, its usefulness in the diagnosis of this
condition and its subsequent management has been proposed (1). Moreover,
FDG PET/CT has been reported to be especially useful in detecting bone
lesions because it is difficult to detect bone sarcoidosis involvement
using conventional radiography (2). Sarcoidosis can affect any site in
the body while being asymptomatic. Therefore, FDG PET/CT should be
considered for the detection of affected lesions of sarcoidosis.