Poliartralgia como primer síntoma de sarcoidosis / Polyarthralgia as an initial symptom of sarcoidosis

RESUMEN

Varón de 39 años que acude a la consulta de Atención Primaria por un cuadro de poliartralgia migratoria, con proteína C reactiva de 7,99 mg/dl, velocidad de sedimentación globular (VSG) de 89 mm y valores de antiestreptolisina O (ASTO) normales. En la consulta de reumatología se le realiza analítica enzima conversora de la angiotensina (ECA), 72 U/I; factor reumatoide, proteína C reactiva y ASTO, normales, y HLA inespecífico. La radiografía de tórax muestra aumento de la trama intersticial pulmonar. En la TC torácica aparecen nódulos pulmonares bilaterales y adenopatías mediastínicas múltiples. Se plantea el diagnóstico diferencial de proceso linfoproliferativo mediastínico, realizándose gammagrafía con galio sin hallazgos. El paciente se deriva a Cirugía Torácica para realizar una biopsia de adenopatía por mediastinoscopia, con resultado de linfadenitis granulomatosa no necrosante compatible con sarcoidosis. Se comienza tratamiento con prednisona y terapia antiosteoporótica, evaluándose al paciente en 4 meses con nueva radiografía de tórax. Se observa remisión clínica y radiológica y se pauta la reducción progresiva de la corticoterapia (AU)

ABSTRACT

A 39 year-old patient consulted his family doctor due to migratory polyarthralgia, with C-reactive protein 7.99 mg/dl, ESR 89 mm and normal anti-streptolysin O (ASO). A sample was taken for analysis in the Rheumatology Clinic ACE 72 IU, with normal rheumatoid factor, C-reactive protein and ASO; HLA non-specific. Chest X-ray showed an increased pulmonary interstitial pattern, and his chest-CT showed multiple bilateral pulmonary nodules and mediastinal lymph nodes. A differential diagnosis of lymphoproliferative process was considered. A gallium scintigraphy was performed with no relevant findings. The patient was referred to Thoracic Surgery for a lymph node biopsy by mediastinoscopy, which showed a non-necrotizing granulomatous lymphadenitis consistent with a sarcoidosis. Treatment with prednisone and anti-osteoporosis drugs was started and the patient was evaluated at four months with a new chest X-ray. There was a clinical and radiological remission therefore it was decided to gradually reduce the corticosteroid therapy (AU)