{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:14:01Z","timestamp":1760058841516,"version":"build-2065373602"},"reference-count":10,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Natural Science Foundation of Guangdong Province","award":["2024A1515013043"],"award-info":[{"award-number":["2024A1515013043"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Sarcoidosis is a rare multisystem inflammatory disease characterized by non-necrotizing granulomas, typically affecting the lungs, lymph nodes, skin, and bones. Due to its extreme clinical heterogeneity, diagnosis remains challenging. Within the skeletal system, the thoracic spine, ankles, and knees are the most commonly involved joints. We report a rare case of non-articular osseous sarcoidosis with progressive pulmonary lesions and persistently normal inflammatory biomarkers (ACE, CRP, ESR, IL-2, and TNF-\u03b1) that required differentiation from metastatic bone tumors and tuberculosis. Prior to presentation at our hospital, the patient did not respond to six months of anti-tuberculosis treatment and one month of systemic glucocorticoid therapy in three other hospitals. Based on lung and bone biopsies, she was finally diagnosed as having active sarcoidosis in our hospital. Despite 3 months of prednisone, pulmonary consolidation and bone lesions persisted until methotrexate was added. This case highlights the preference of combined glucocorticoid and methotrexate therapy for sarcoidosis with atypical osseous involvement and normal biomarkers, underscoring the urgent need for novel diagnostic tools to mitigate misdiagnosis.<\/jats:p>","DOI":"10.3390\/diagnostics15091135","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T11:00:54Z","timestamp":1745924454000},"page":"1135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-Articular Osseous Sarcoidosis: A Rare Case of Active Sarcoidosis with Progressive Lung Lesions and Normal Inflammation Biomarkers"],"prefix":"10.3390","volume":"15","author":[{"given":"Jing","family":"Zhang","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China"},{"name":"Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Hu","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China"},{"name":"Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peixin","family":"Dong","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China"},{"name":"Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hefang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hexian Memorial Hospital of PanYu District, Guangzhou 511400, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lixia","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China"},{"name":"Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanbin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China"},{"name":"Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.rmed.2014.11.009","article-title":"ACE and sIL-2R correlate with lung function improvement in sarcoidosis during methotrexate therapy","volume":"109","author":"Vorselaars","year":"2015","journal-title":"Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1164\/rccm.202106-1366CI","article-title":"Management of Advanced Pulmonary Sarcoidosis","volume":"205","author":"Gupta","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1007\/s00296-022-05171-8","article-title":"Sarcoidosis with musculoskeletal manifestations: Systematic review of non-pharmacological and pharmacological treatments","volume":"42","author":"Smedslund","year":"2022","journal-title":"Rheumatol. Int."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Patt, Y.S., Ben-Shabat, N., Sharif, K., Patt, C., Elizur, Y., Arow, M., Cohen, A.D., Watad, A., McGonagle, D., and Amital, H. (2024). The Association Between Sarcoidosis and Malignancy: A Comprehensive Population-Based Cohort Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237045"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1093\/postmj\/qgae045","article-title":"Temporal relationship between sarcoidosis malignancies in a nationwide cohort of 1942 patients","volume":"100","author":"Alguacil","year":"2024","journal-title":"Postgrad. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s00408-021-00485-z","article-title":"Clinical Characteristics of Sarcoidosis Patients with Self-Reported Lymphoma: A US Nationwide Registry Study","volume":"199","author":"Alzghoul","year":"2021","journal-title":"Lung"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"226","DOI":"10.3960\/jslrt.22015","article-title":"Diffuse large B-cell lymphoma in the course of systemic sarcoidosis: A case report and review of 30 Japanese patients with sarcoidosis-lymphoma syndrome","volume":"62","author":"Matsuo","year":"2022","journal-title":"J. Clin. Exp. Hematop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1080\/17476348.2019.1655401","article-title":"New concepts in the pathogenesis of sarcoidosis","volume":"13","author":"Bennett","year":"2019","journal-title":"Expert. Rev. Respir. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s12016-015-8478-7","article-title":"Imaging of Sarcoidosis","volume":"49","author":"Silva","year":"2015","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_10","first-page":"15378","article-title":"Deep learning approaches to predict late gadolinium enhancement and clinical outcomes in suspected cardiac sarcoidosis","volume":"42","author":"Azoulay","year":"2025","journal-title":"Sarcoidosis Vasc. Diffuse Lung Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/9\/1135\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:24:14Z","timestamp":1760030654000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/9\/1135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":10,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["diagnostics15091135"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15091135","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,4,29]]}}}