[Solitary tumorous muscular sarcoidosis (granulomatous myopathy) of the forearm extensors].

INTRODUCTION

Besides the lung and hilar lymph nodes, sarcoidosis may affect almost every other organ. Under the aspect of histology, non-caseating granulomas are normally found in sarcoidosis but also appear in connection with other diseases. Therefore some authors prefer the definition "granulomatous myopathy" in the case of solitary muscular affection as long as sarcoidosis is not found in at least two other organs. Others, however, speak of "solitary muscular sarcoidosis", if any other origin can be excluded.

CASE REPORT: A 20-year old man mentioned a painless swelling in his left forearm. During a 6-year follow-up, intermittent growth with long intervals of inactivity could be ascertained. The diagnosis was supported by two biopsies within three years. Under oral therapy with prednisone the tumor decreased evidently.

REVIEW OF LITERATURE: Out of 61 cases of tumorous sarcoid myopathy described in literature, only 9 lesions appeared in just one location. Three of these 9 showed no evidence of disease in other organs and referred to lower limbs of Japanese. As far as we know a unilocular solitary tumorous sarcoid myopathy of the upper limb has not yet been described.

CONCLUSION

The tumorous sarcoid myopathy is mainly located between the muscle fibers. Therefore paralysis, atrophy and contracture is rarely discovered in this kind of sarcoid myopathy. It shows a slow "stop-and-go" progress and may spontaneously go in remission. The expected success of therapy is therefore to be carefully considered in every incidence in view of side-effects. Oral prednisone with an initial dose of 1mg per kg body weight per day seems to be the most effective therapy. A moderate dose reduction prevents recurrence.