Unusual Presentations of Pulmonary Sarcoidosis: Cases from the Medical University of South Carolina

Abstract

Sarcoidosis is a multisystem granulomatous disease that can affect any organ in the body, but most commonly the lung. Any part of the thorax may be affected by sarcoidosis, including the lung parenchyma, airways, and mediastinal and hilar lymph nodes. When the parenchyma is involved, sarcoidosis has a predilection for the bronchovascular bundles and subpleural locations. On occasion, the presentation of pulmonary sarcoidosis may be atypical. Atypical presentations may result in a delay in diagnosis as well as unnecessary treatment or diagnostic testing. We discuss four patients with an unusual presentation of thoracic sarcoidosis seen at our Sarcoidosis Clinic.

Sarcoidosis: an underrecognised cause for bullous lung disease?

“…The condition was first reported in 1949 by ZIMMERMAN and MANN [1]. A Medline search has further revealed a total of 17 more case reports of bullous sarcoidosis since then [1][2][3][4][5][6][7][8][9][10].…”

“…Males were more frequently affected than females in a ratio of 2:1. In only half of the cases was the race specified [1,3,5,7,9,10] and no ethnic differences in incidence was noted. Most patients had been noted to have bullous changes within 3-4 yrs of symptom development [2][3][4]7].…”

“…Most patients had been noted to have bullous changes within 3-4 yrs of symptom development [2][3][4]7]. In four patients, the symptoms had been attributed to asthma or chronic obstructive pulmonary disease (COPD) [7,9,10]. Smoking history was not specified in six of the 18 case reports.…”

Granulomatous Sarcoidosis Mimics

“…These findings are not common with pulmonary sarcoidosis, but may be seen (17,18). The radiographic findings of primary tuberculosis include hilar and mediastinal lymphadenopathy, pleural effusion, and a solitary pulmonary nodule that have all been reported in cases of pulmonary sarcoidosis (18)(19)(20).…”

Sarcoidosis in the aged: review and management

“…CT-guided transthoracic fine needle aspiration and core needle biopsy of the nodule showed noncaseating granulomas. Gallium-67 scintigraphy showed increased uptake in the left hilar region corresponding to the lymphadenopathy found on the chest CT. She remained asymptomatic and has not received any treatment for her sarcoidosis in the 5-year follow-up [40].…”