Sarcoid myositis is a systemic disorder of unknown cause.1
It is characterised by non-caseating granulomas.2
It can be classified into three types: chronic myopathy, palpable nodules and acute myositis. Chronic myopathy is a condition wherein the disease has a steady and slow progress. In this condition, the patient has proximal myopathy bilaterally and symmetrically, and the creatine kinase levels are normal.
The second type is palpable nodules, where the patient presents with painful nodules on the muscles of the extremities, and muscle biopsy specimens reveal non-caseating granulomas.3
This type of sarcoid myositis is not associated with muscle weakness.
The third type is the rarest manifestation that this patient presented with – acute sarcoid myositis.4
There have only been 20 acute cases reported in the literature. It usually presents in females aged 40–55 years. Most patients report acute or insidious respiratory problems, as well as proximal muscle weakness. It mimics polymyositis. It usually involves chronic self-limited episodes of relapse and remission of symptoms. Investigations reveal a creatine kinase of around 2000, and the condition itself is diagnosed via MRI and muscle biopsy. The treatment of choice is steroids.5
Our case is different from most other published cases in the literature in that the patient had not been diagnosed with sarcoidosis. The patient had no respiratory symptoms, and the chest x-ray did not show hilar lymphadenopathy. It was also unusual that it was initially thought for many years to do with the underlying hip prosthesis.
The patient is doing better with regard to her condition. However, certain complications as a result of the diagnosis must be monitored. Complications with regard to the condition include respiratory complications.6
She now has regular lung function tests and chest follow-up. Complications that are important as a result of the steroid treatment include osteoporosis. This is particularly important given her orthopaedic issues. She is currently being regularly followed up by the orthopaedic and rheumatology team, and is on regular bisphosphonates.
- Clinical history and examination are the most important tools in making a diagnosis.
- There should be early involvement of the multidisciplinary team in complex cases.
- Sarcoidosis may present with the symptoms of muscular pain.