Acute alveolar sarcoidosis presenting with hypoxaemic respiratory failure

Abstract

Alveolar sarcoidosis is a less commonly seen pulmonary manifestation of the disease. An acute presentation of this radiological pattern with hypoxaemic respiratory failure has been documented only once, four decades ago. A 30-year-old man presented with acute onset of progressive and persistent dyspnoea over 20 days ago with hypoxaemic respiratory failure. Imaging demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities having ill-defined margins along with air bronchograms in the mid and lower zones bilaterally, suggestive of alveolar sarcoidosis. A restrictive pattern with a diffusion defect was seen on pulmonary function testing. Bronchoscopic evaluation revealed non-caseating granulomas on histopathology confirming pulmonary sarcoidosis. This was further supported by an elevated serum ACE level and negative Mantoux test. Oral prednisolone elicited a rapid clinical and radiological response. Alveolar sarcoidosis can rarely present acutely with hypoxaemic respiratory failure, which can respond remarkably and expeditiously to appropriate therapy.

Differences in Mechanisms of Steroid Therapy and Olfactory Training for Olfactory Loss in Mice

“…Steroids are useful for the treatment of a wide range of inflammatory and autoimmune conditions such as allergic rhinitis, asthma, rheumatoid arthritis, urticaria, angioedema, ulcerative colitis, autoimmune hepatitis, and systemic lupus erythematosus. [31][32][33][34][35][36] Corticosteroids Figure 1. Histological changes in olfactory neuroepithelial tissue were evaluated after 2 weeks of olfactory training (OT) and steroid treatment.…”

Pulmonary Sarcoidosis Presenting with Acute Respiratory Failure: A Report of a Case Diagnosed by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration on Ventilation after Intubation

“…Dyspnea and respiratory failure are uncommon and usually associated with advanced pulmonary fibrosis ( 17 ). Pleural effusion is also very rare, but sarcoidosis with acute respiratory failure sometimes involves pleural effusion ( 4 , 5 , 11 ). The acute presentation of sarcoidosis is well recognized as Lofgren’s syndrome, which is characterized by hilar adenopathy, erythema nodosum, and arthritis ( 18 , 19 ).…”

“…Acute respiratory disorders are rare and usually occur in advanced sarcoidosis based on previous respiratory infectious diseases, like pneumonia or, more specifically, bronchospasm, in cases where the airways are hyperresponsive due to granulomatous inflammation or are injured due to fibrocystic pulmonary sarcoidosis ( 3 ). An acute initial presentation with respiratory failure in a previously undiagnosed patient is rare, and only a few cases have been reported ( 4 - 11 ).…”

Sarcoidosis Presenting as Acute Respiratory Distress Syndrome

“…Interestingly, most patients diagnosed with alveolar sarcoidosis also did not present with respiratory failure. Two such cases have been documented, by Sahn et al [11] and Gera et al [6].…”