Unusual presentation of necrotising sarcoid granulomatosis in the liver, spleen and bone

Sarcoidosis is an inflammatory multisystem disease characterised by non-necrotising granulomas that typically affect the lungs, lymph nodes, eyes, skin, liver, spleen, heart, bones and joints. Although rare, necrotising granulomas can also occur. In this report, we present a case of a healthy woman in her 60s who presented with a 1-year history of fatigue and generalised body aches. A comprehensive diagnostic workup, including a detailed history, physical examination, blood tests, imaging studies (CT and positron emission tomography-CT) and biopsies, was conducted to identify the underlying cause. Biopsy results confirmed the presence of necrotising granulomas, leading to a diagnosis of extrapulmonary sarcoidosis after excluding other aetiologies. The patient was treated with a multiregimen therapeutic approach, including adalimumab, which resulted in significant clinical improvement.