Vertebral and rib sarcoidosis: Long-term clinical remission with methotrexate

We describe a patient with bilateral hilar lymphadenopathy shown on a chest radiograph and supraclavicular lymphadenopathy, Biopsy of a supraclavicula r lymph node showed non-caseating granulomas, A diagnosis of sarcoidosis wa s made and no treatment was given. One year later she complained of cervica l and lumbar pain and decreasing strength of the right hand. Magnetic reson ance imaging of the spine showed multiple lesions within the vertebral bodi es of six vertebrae, and thoracic computed tomography showed partial destru ction of the first right rib. A biopsy of the second lumbar vertebra demons trated non-caseating granulomas. Corticosteroid treatment was unsuccessful and long-term remission of the symptoms was achieved with a weekly low dose of methotrexate.