The Osseous Lesions of Sarcoidosis

Abstract

In the fifty years which have passed since Caesar Boeck (1) first described an apparently rare dermatologic condition which he chose to call “multiple benign sarkoid of the skin,” this disease has come to be recognized as a generalized systemic disorder of interest and importance not only to dermatologists but to physicians in virtually all branches of medical practice. On occasion sarcoid lesions apparently confined to the skin are encountered, but the consistency with which deep-seated sarcoidosis occurs with or without skin alterations warrants thorough investigation of all organ-systems of patients in whom the disease is suspected. The evolution of sarcoidosis as we now recognize it has been carefully documented by many writers, notably Hunter (2) and Longcope and Pierson (3). Their accounts of Hutchinson's “Mortimer's malady,” Besnier's lupus pernio, Boeck's multiple benign sarcoid, Heerfordt's uveoparotid fever, Schaumann's lymphogranuloma benignum, Jüngling's osteitis tuberculosa multiplex cystica, and certain instances of the Mikulicz syndrome, and how all these apparently specific diseases were gradually recognized as different manifestations of a single clinicopathologic entity constitute one of the most fascinating chapters in the history of medicine. Nor has the chapter yet ended, for not only do each few years bring reports of sarcoidosis involving portions of the body in which it has not hitherto been described and new tests for the determination of its presence (4, 5), but the etiology of the condition never has been satisfactorily established. Schaumann (6, 7), who made the first real attempt to correlate the various clinical and pathological manifestations of sarcoidosis, insists that the disease is primarily one of the lymphohematopoietic system, with or without involvement of the skin, and that the reporting of lesions in other portions of the body represents a failure to distinguish “what is essential and what is accidental.” Like Besnier (8), Boeck (1), and Jüngling (9), as well as the majority of modern authorities, Schaumann has consistently maintained that sarcoidosis is a peculiar manifestation of tuberculosis. One can find considerable support for this theory in the contributions of various laboratory research workers. For example, Jadassohn (10) has produced sarcoid-like lesions in the skin of rats by injection of tubercle bacilli, and Florence Sabin (11) and her co-workers have obtained non-caseating “hard” tubercles typical of sarcoid by injecting only the lipoid fraction of tubercle bacilli into laboratory animals. On the other hand, it has been found that sarcoid-like lesions can be produced locally by the injection of other organisms (12) as well as by numerous inert substances such as grass (12) and silica (13).