Abstract
Typical presentations of sarcoidosis are easily diagnosed. Atypical forms have unusual presentation making diagnosis hard.
We studied four cases with unusual presentations of thoracic sarcoidosis.
Over a period of 7 years we diagnosed intrathoracic sarcoidosis in four male patients. Clinical and radiological characteristics were reviewed.
The mean age was 40 years. All cases had fever, sweat and respiratory symptoms including dyspnea, cough and chest pain. Chest X ray and CT scan showed bilateral hilar lymphoma in all cases, with multiple large lung nodules in one case, cavitation in one case and large alveolar opacity in another case. Tissue biopsy showed in all cases non-caseating granuloma, by bronchial lung biopsy in one case, peripheral lymph node in one case, skin biopsy in one case and by mediastinoscopy in another case.
Diagnosis of tuberculosis was initially evoqued in two cases but the outcome was non favorable under antituberculous therapy and diagnosis was revised. In one case, diagnosis of BOOP was suspected but skin biopsy confirmed sarcoidosis. In another case, multiple large disseminated lung nodules led for a rather neoplasic diagnosis.
Diagnosis of unusual presentations of sarcoidosis requires the association of clinical features, evidence of non caseating granuloma in histologica and exclusion of infection, malignancy and other granulomatous diseases.
- © 2011 ERS
