A Case of Boeck's Sarcoid with Isolated Localization in the Musculature

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Abstract
Summary Boeck's sarcoid with isolated ocalization in the musculature is a disorder that is only seldom seen. In most cases the muscles are affected simultaneously with other tissues and organs, and then the symptoms do not give rise to differential diagnostic difficulties. The patients generally complain of pain and loss of strength in the musculature affected. Physical examination shows a varying degree of loss of strength, palpable nodular infiltrates in the muscles or, in rarer cases, with progressive muscular atrophy as the only symptoms. In the case of purely muscular localization the diagnosis of Boeck's sarcoid can only be established by muscle biopsy. In the present case the patient, a joiner, aged 38, complained of pain and increasing loss of strength, first in the right, later in the left shoulder and upper arm. Physical examination showed weakening and atrophy of both shoulder girdles and of the flexor muscles of the right elbow-joint. No palpable changes were found in the muscles involved. Otherwise, clinical examination, including radiography of the heart and the lungs, did not suggest the presence of a systemic disorder. The result of electromyography was rather indicative of a neurogenous affection. The differential diagnoses of progressive muscular atrophy, myositis and peripheral motor neuritis were then considered. However, a biopsy from one of the paretic muscles showed granuloma-formation of the same type as that seen in Boeck's sarcoid. Prompt effect was obtained with corticotrophin treatment in conjunction with adequate physical training of the affected muscles.

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