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Sarcoidosis with multiorgan involvement
  1. Thotsaporn Morasert1,
  2. Makamas Jongjaroonrangsun2,
  3. Siraprapa Smithtithiti3,
  4. Kanyaprin Bhummichitra3
  1. 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Suratthani Hospital, Surat Thani, Suratthani, Thailand
  2. 2 Department of Radiology, Suratthani Hospital, Surat Thani, Surat Thani, Thailand
  3. 3 Department of Pathology, Suratthani Hospital, Surat Thani, Surat Thani, Thailand
  1. Correspondence to Dr Thotsaporn Morasert, Pulmonary and Critical care Medicine, Department of Medicine, Suratthani Hospital, Surat Thani, Suratthani 84000, Thailand; thot_kwan{at}hotmail.com

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A 27-year-old man presented with progressive dyspnoea and cough for 1 year. Six months earlier, he was diagnosed and received complete treatment for smear-negative pulmonary tuberculosis (TB) without clinical and radiography improvement. Physical examination revealed right eye uveitis, left cervical lymphadenopathy and minimal crepitation at both basal lungs.

The CT scan showed perilymphatic nodules and reticular infiltrations in both lungs, mainly along with peribronchial distribution, upper lobes predominance, and mediastinal lymphadenopathy involving right paratracheal and both hilar (figure 1) and left kidney stone. The bronchoscope demonstrated diffuse endobronchial nodules (figure 2). The biopsies of endobronchial nodules (figure 3) and cervical lymph nodes showed non-necrotising granulomatous inflammation. All biopsy specimens and bronchial washing culture were negative for TB.

Figure 1

CT chest: axial lung window view (A) and soft tissue window view (B) showing irregular perilymphatic nodules, reticular infiltrations, interlobular septal thickening, traction bronchiectasis, bullaeformation and multiple mediastinal lymphadenopathy compatible with stage II disease (bilateral hilaradenopathy and parenchymal infiltrations).

Figure 2

Endobronchial views of left main bronchus showing diffuse erythema and a nodular, cobblestone appearance.

Figure 3

H&E stain, the histomorphology of endobronchial biopsy revealed small foci of non-necrotising granulomatous inflammation admixed with benign bronchial tissue (GMS, PAS, AFB and modified AFB stain: negative). AFB, acid fast stain; GMS, Grocott methenamine silver; PAS, periodic acid–Schiff.

Sarcoidosis is a multisystem non-caseating granulomatous disease of unknown aetiology that affects relatively young adults.1 The term ‘Sarkoid’ (‘Sark’ and ‘oid’ meaning flesh-like) derived from lesions resembled sarcoma but were benign.2 The previous report suggested that sarcoidosis was a disease of the developed world,3 but rare in East Asian.4

This case demonstrated a young Thai man with multiorgan involvement by sarcoidosis that misdiagnosis as more common TB disease. Clinical presentations of sarcoidosis are heterogeneous and overlap with many diseases. Lungs are the most involved organ in 95% of cases.5 The Chest radiography abnormality is usually a key step for diagnosis and has been classified in stages I–IV.1 Although a definitive diagnostic test for sarcoidosis does not exist, the diagnosis usually requires three components: first, compatible clinicoradiological finding; second, exclusion of the other diseases; and third, histological evidence of non-caseating granulomas in >1 organ.

References

Footnotes

  • Contributors TM: was in charge of the patient, wrote the first draft and submitted the manuscript. MJ: prepared the CT image and report. SS and KB: prepared the pathological image and report. All authors approved the final version.

  • Funding Medical education centre of Suratthani Hospital, Thailand.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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