Als Spondylodiszitis imponierende vertebrale Sarkoidose

Sarcoidosis is a multisystem disorder of unknown cause characterized by non-caseating granulomatous infiltration affecting multiple organs. Osseous involvement has been estimated to occur in up to 13% cases. Due to its rare occurrence, only a few cases of vertebral sarcoidosis have been reported. Including our case, there are only three reports of vertebral sarcoidosis causing instability being treated by surgical fusion. The 54-year-old male patient presented with severe back pain, which had significantly impeded his mobility for months. He was unresponsive to analgesic and non-steroidal anti-inflammatory drugs (NSAID) and also reported weight loss and progressive weakness. Laboratory tests showed no specific alterations. When an MRI revealed destructive vertebral lesions of the lower thoracic spine, a tentative diagnosis of pyogenic discitis was made. For spinal stabilization as well as infection control, sequential operations were performed: dorsal spinal fusion by means of an internal fixation system was followed by excision of vertebrae 7/8 and filling of the defect with an autologous tricortical iliac crest bone graft through a ventral approach. Histological section of the excised vertebrae demonstrated a non-caseating granulomatous infiltration. Once this was determined, treatment with corticosteroids was started. The patient made a complete recovery and remains pain-free.