Diagnosis: Osseous Sarcoidosis

History: 48 year old male presents with pain in fingers of both hands. He has a 25 year history of sarcoidosis diagnosed via epitrochlear lymph node biopsy in 1982. The patient has a questionable history of lung involvement as demonstrated by nonspecific spirometry changes with normal chest radiography, which is confused by his history of chronic bronchitis. The patient has suffered joint (shoulder, ankle, and knee) pain and skin symptoms for several years.

Findings: Bilateral radiographs of the hands in the “Catcher’s or Norgaard view show abnormalities of the left hand including osteopenia with lacy reticulation of phalanges of the fifth finger

Ddx: Osteoporosis/Osteopenia Osteoarthritis Malignancy Sarcoidosis

Dxhow: Imaging coupled with biopsy confirmed sarcoidosis

Exam: Vital signs WNL Hands: Swelling of proximal interphalangeal joints of both hands without tenderness, warmth, or erythema Skin: plaque-like thickening and areas of hyper and hypopigmentation of the skin of upper arms, upper back, neck and scalp.