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Case of the Week 327

What's the most likely diagnosis?

  • 43 year-old woman presents with pain and swelling

  1. Psoriasis
  2. Metastatic disease
  3. Sarcoid
  4. Hyperparathyroidism
  5. Reiter's syndrome

Additional Images - Frontal view of both hands


Additional Images

Frontal view of both hands


3. Sarcoid

More (Click Discussion Tab)

Sarcoid of the feet and hands

General Considerations

  • Radiographic evidence of osseous involvement occurs in about 5% of patients with sarcoidosis
    • Arthralgia in patients with sarcoid may occur in up to 1/3 of patients
  • Patients are usually between 20-40, more frequently women
  • Typically affects multiple joints
  • Most often affects hands, feet and ankles (the latter in acute form)
    • Lesions in long bones, skull or spine are rare
  • Often occurs in association with pre-existing pulmonary and/or skin lesions such as lupus pernio
    • Purplish, indurated macules or papules on the face considered classic for sarcoid
  • May occasionally be presenting manifestation of sarcoid

    More ...

    This Week

    43-year-old woman presents with pain and swelling

    Review Jefferson, dens, Hangman's, extension-teardrop, burst and compression fractures, their mechanisms and their radiographic appearances. This podcast also examines slipped, perched and locked facet injuries.


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