A 43-year-old black woman, a lifelong nonsmoker, presented with
a cough of 9 months’ duration. Initially, her cough was nonproductive.
Later, she produced sputum and occasionally had bouts of hemoptysis.
Two months prior to presentation, she developed painful, red eyes,
which transiently responded to cold compresses. Later, she also noticed
a red spot on her lower right shin which was painful, but it resolved
spontaneously. One month prior to presentation, she noted dyspnea. She
went to the emergency department with the preceding complaints and was
referred to a pulmonologist because sarcoidosis was suspected.
Spirometry values revealed a FVC of 62% of predicted and a
FEV1 value of 59% of predicted. A chest CT scan (Fig 1)
and chest radiograph (Fig 2) were performed. Sputum specimens were
negative for tuberculosis. A transbronchial biopsy revealed
noncaseating granuloma with stains and cultures negative for fungi and
mycobacteria; therefore, the biopsies were consistent with sarcoidosis.
Therapy with corticosteroids was started. Her pulmonary symptoms and
spirometric abnormalities resolved within 6 months.