PO37 - Happy Ending Story: A Case of Sarcoidosis
Feride Marim (Turkey)1; Zeynep Yaren Yilmaz Tan (Turkey)1; Umran Erbay (Turkey)1; Sertas Erarslan (Turkey)2; Mehmet Korkmaz (Turkey)3;
1 - Kutahya Health Sciences University, Faculty of Medicine, Department of Chest Diseases; 2 - Kutahya Health Sciences University, Faculty of Medicine, Department of İnternal Medicine; 3 - Kutahya Health Sciences University, Faculty of Medicine, Department of Radiology;
Keywords: sarcoidosis; mass; lymphadenopathy;
Select the theme: Challenges in Sarcoidosis Diagnosis and Staging
Type: Clinical Cases
Presentation: Poster Presentation

Introduction: Sarcoidosis is a multisystem granulomatous disease. We present a case with atypical findings.

 

Clinical Case Description: A 40-year-old female patient presented to our clinic with loss of appetite, weight loss, night sweats, back pain, and dyspnea. She was a supermarket employee with a history of 15 pack-years of smoking. Her CA-125 level was elevated. A chest CT scan revealed bilateral, diffusely distributed patchy ground-glass opacities and consolidation areas measuring 4–5 cm in size. PET-CT revealed mediastinal and hilar lymphadenopathy (SUVmax: 8.4) and bilateral diffuse parenchymal opacities (SUVmax: 16.4) (Figure 1). Bronchoscopy showed no endobronchial lesions. Bronchial lavage revealed a predominance of neutrophils. Tru-cut parenchymal biopsy was performed. Non-necrotizing granulomatous inflammation was observed. Abdominal imaging and rheumatological evaluation was normal. Serum ACE level was 82 U/L. An excisional axillary lymph node biopsy was performed. Similar findings of non-necrotizing granulomatous inflammation were observed. Granulomatous infectious diseases were ruled out. In pulmonary function tests, FVC was 2.58 L/m² 76%, and DLCO was 80%. The tuberculin skin test was negative. The patient was started on a treatment regimen of 0.5 mg/kg/day of methylprednisolone following a diagnosis of sarcoidosis. Clinical symptoms improved significantly during the first month of steroid therapy. By the third month of treatment, a marked regression of radiological findings was observed on the chest X-ray (Figure 2). It was planned to complete steroid therapy for at least 6 months.

Conclusions: In sarcoidosis, typical radiological findings include hilar and mediastinal lymphadenopathy, perilymphatic nodules, and sarcoid galaxies. Rarely, cases may present with atypical radiological findings such as consolidation, masses, ground-glass opacities, and localized air trapping. In our case, which we initially followed up with a preliminary diagnosis of metastasis or lung cancer based on clinical and radiological findings, we ultimately diagnosed sarcoidosis. With steroid treatment, the patient’s story is nearing a happy ending.

Figure 1: A–C: Patchy consolidation and ground-glass opacities appearing as bilateral mass-like lesions on chest CT D–F: On PET-CT, widespread mediastinal and hilar lymphadenopathy (SUVmax: 8.4) and pathological FDG uptake were detected in diffuse parenchymal opacities in both lungs, the largest of which was in the superior segment of the left lower lobe (SUVmax: 16.4).Figure 2: A: The chest X-ray in the initial evaluation shows bilateral diffuse patchy opacities and left hilar enlargement. B: By the 4th month of treatment, there is a marked regression of the findings on the chest X-ray.