ROLE OF MRI IN DIAGNOSIS OF CHILDHOOD SARCOIDOSIS WITH FEVER OF UNKNOWN ORIGIN

Childhood sarcoidosis is a disease with multisystem organ involvement, and initial presentation as fever of unknown origin (FUO) is relative ly common. We describe herein three children (aged 9, 7, and 11 years) with sarcoidosis who were seen initially with FUO. Common clinical an d laboratory features include fever of >2 weeks' duration, weight loss , fatigue, leg pain, anemia, increased erythrocyte sedimentation rate, elevated immunoglobulin G level, negative antinuclear antibodies and rheumatoid factor? and negative purified protein derivative and Candid a skin tests. Two patients had iridocyclitis, one had hilar adenopathy , and two had angiotensin-converting enzyme serum levels. All three ha d no evidence of pulmonary infiltrates on chest radiographs. Bone marr ow biopsies for all three were normal, and with no evidence of maligna ncy. Plain radiographs of the lower extremities and bone scan were nor mal. Magnetic resonance imaging (MRI) of the lower extremities reveale d intact bone architecture and multifocal nodular lesions within the m arrow. Bone biopsy from the tibia performed on two patients showed nor mal bone trabeculae and a solitary noncaseating epithelioid cell granu loma. Noncaseating granuloma was found on reevaluation of the bone mar row biopsy in the third patient. All three patients had negative marro w stains and cultures for fungi and mycobacteria. We conclude that MRI was very useful in the diagnosis of sarcoidosis in children with FUO.