Management of a patient with sarcoid calcaneitis and dactylitis

Dactylitis and calcaneitis developed in a patient with untreated sarcoidosi s of the skin and lungs. Radiographs showed a defect in the second phalanx of the left middle finger. Radiographs of the feet were normal, but magneti c resonance imaging demonstrated a defect in the left calcaneus. Methylpred nisolone therapy (1 g per day for 3 consecutive days) induced a dramatic im provement within 48 hours. Low-dose oral glucocorticoid therapy was given s ubsequently. One year later, a recurrent episode of dactylitis responded pr omptly to the same regimen. Maintenance therapy was given, and no further r ecurrences were noted during the four-year follow-up. Sarcoid bone lesions are uncommon and arise selectively in the small bones of the hands and feet . Involvement of the calcaneus is exceedingly rare, and its treatment is no t standardized. In our patient, glucocorticoid therapy combined with methot rexate and hydroxychloroquine were effective in controlling the disease. Jo int Bone Spine 2001 ; 68 : 175-7. (C) 2001 Editions scientifiques et medica les Elsevier SAS.