Extrapulmonary Sarcoidosis: A Diagnostic Challenge

Extrapulmonary sarcoidosis accounts for only two percent of the total sarcoid cases. Sarcoidosis affecting the musculoskeletal system alone is even rarer. Diagnosis is based on suggestive history, clinical features, imaging followed by confirmation of non-caseating granulomas on a biopsy. Steroids form the first line of treatment for patients where musculoskeletal system is involved. We report the case of a 26-year-old gentleman who presented with right foot pain and unintentional weight loss. A magnetic resonance imaging (MRI) scan of feet confirmed bilateral stress fractures of both feet. After a battery of investigations and resultant myriad constellation of investigation findings, the diagnosis of sarcoidosis was confirmed on a tissue biopsy obtained via bronchoscopy. This case report discusses the complex journey from presentation to diagnosis and subsequent treatment while also exploring important differentials that need to be ruled out in such scenarios.