INTRODUCTION: Sarcoidosis is a multisystem disease which commonly involves pulmonary parenchyma and lymph nodes. Air flow obstruction due to sarcoidosis is common and is thought to be due to diffuse endobronchial involvement (1).Focal endoluminal stenosis has been described but is rare(2). We present a case of endobronchial sarcoidosis with endoluminal stenosis and discuss the role of endobronchial interventions in treatment.
CASE PRESENTATION: A 28-yo caucasian woman with diagnoses of asthma, sarcoidosis, and obesity was referred for worsening dyspnea, arthralgias, and facial erythematous rash. Symptoms were unresponsive to high-dose inhaled corticosteroids and bronchodilators. A trial of systemic glucocorticoids improved her rash and arthralgias, but her dyspnea persisted. Serial pulmonary function tests demonstrated worsening of both air flow obstruction and air trapping. A computed tomographic scan of her chest was read as normal. Flexible bronchoscopy revealed web-like obstruction of most segmental bronchi. Endobronchial biopsies of these abnormalities demonstrated non-caseating granulomas, confirming a diagnosis of endobronchial sarcoidosis. Serial interventional bronchoscopies using a combination of electrocautery, balloon bronchoplasty, and endobronchial steroid injection led to marked improvement in both symptoms and airflow parameters.
DISCUSSION: Web-like segmental airway obstruction is a rare but reported presentation of sarcoidosis. In our opinion patients with sarcoid who have air flow obstruction refractory to steroid therapy, at least one bronchoscopy is warranted.
CONCLUSIONS: This case highlights the potential utility of endobronchial interventions in treatment of this rare variant of sarcoid-related endobronchial stenosis.
Reference #1 Harrison BD, Shaylor JM, Stokes TC, Wilkes AR. Airflow limitation in sarcoidosis--a study of pulmonary function in 107 patients with newly diagnosed disease. Respir Med. 1991 Jan;85(1):59-64.
Reference #2 Chambellan A, Turbie P, Nunes H, Brauner M, Battesti JP, Valeyre D. Endoluminal stenosis of proximal bronchi in sarcoidosis: bronchoscopy, function, and evolution. Chest. 2005 Feb;127(2):472-81.
DISCLOSURE: The following authors have nothing to disclose: Nutan Bhaskar, Yousef Shweihat, Thaddeus Bartter
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