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Fluorine-18 Fluorodeoxyglucose with Positron Emission Tomography Revealed Bone Marrow Involvement in Sarcoidosis Patients with Anaemia

Background: Anaemia occurs in 13–28% of sarcoidosis patients. It is associated with bone marrow infiltration by epitheliod granulomas in about 50% of cases, but its pathophysiology remains unclear. Objectives: It was the aim of this study to describe a series of sarcoidosis patients with and without anaemia who underwent metabolic imaging with fluorine-18 fluorodeoxyglucose with positron emission tomography (18F-FDG PET). Methods: The files of 3 sarcoidosis patients who exhibited anaemia and underwent metabolic imaging with 18F-FDG PET were reviewed in comparison with those of all sarcoidosis patients (n = 7) who underwent 18F-FDG PET during the same period of time. Results: In the 3 cases, symptomatic anaemia was associated with bone marrow sarcoidosis as attested by 18F-FDG PET and confirmed by bone marrow biopsy. This observation is strengthened by the lack of bone marrow hypermetabolism by PET scan in the 7 control patients. Corticosteroids dramatically improved anaemia in 2 cases which correlated with a dramatic decrease in bone marrow glucose uptake. In contrast, there was a moderate increase in haemoglobin level in the third case and no change in metabolic imaging. Conclusion: Whole-body 18F-FDG PET imaging should be considered in sarcoidosis patients with symptomatic anaemia. It can noninvasively suggest bone marrow involvement, indicate sarcoidosis treatment and monitor its efficiency.