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Free Content Fever of unknown origin and isolated noncaseating granuloma of the marrow: Could this be sarcoidosis?

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Authors: Miller, Andrew C. 1 ; Chacko, Thomas 2 ; Rashid, Rashid M. 3 ; Ledford, Dennis K. 2 ; 

Source: Allergy and Asthma Proceedings, Volume 28, Number 2, March-April 2007, pp. 230-235(6)

Publisher: OceanSide Publications, Inc

DOI: https://doi.org/10.2500/aap.2007.28.2982

Fever of unknown origin (FUO) is both a clinical and a diagnostic challenge. Furthermore, an FUO case with isolated marrow noncaseating granuloma can further confound diagnosis. However, these two findings together may help narrow down the pathological possibilities. This article presents a case report of FUO and lymphopenia for 2 months. Multiple studies to evaluate infectious etiology were unremarkable. Bone marrow biopsy revealed isolated bone marrow granuloma, suggestive of sarcoid. The patient responded well to glucocorticosteroids with resolution of lymphopenia. Sarcoid should enter the differential of lymphopenia and FUO even without lymphadenopathy or abnormal chest radiography. This article provides a of review of CD4 lymphopenia, noncaseating granuloma of the marrow, and sarcoidosis.

Keywords: BONE MARROW GRANULOMA; CD4 LYMPHOPENIA; FEVER OF KNOWN ORIGIN; NONCASEATING GRANULOMA; SARCOID

Document Type: Case Report

Affiliations: 1: Departments of Internal Medicine and Emergency Medicine, State University of New York Downstate Medical Center and Kings County Hospital Center Brooklyn, New York 2: Division of Allergy and Immunology, University of South Florida College of Medicine and James A. Haley VA Hospital, Tampa, Florida 3: M.D./Ph.D. Program, Loyola University Stritch School of Medicine, Maywood, Illinois

Publication date: March 1, 2007

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