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Disorders of the Pleura |

A Case of Hemorrhagic Pleural Effusion Secondary to Sarcoidosis

Ramakrishna Chakilam*, MD; Vishal Poddar, MD; Mallika Godasi, MD; Prema Madhuri Pamireddy, MD; Alicia Thomas, MD; Octavius Polk, MD
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Howard University Hospital, Washington, DC


Chest. 2012;142(4_MeetingAbstracts):498A. doi:10.1378/chest.1388573
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Abstract

SESSION TYPE: Pleural Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoidosis is a granulomatous disease of unknown etiology. Most commonly involved organs are lungs, skin, eyes and lymph nodes. Pleural involvement in Sarcoidosis is rare

CASE PRESENTATION: A 40 year old African American female patient was recently diagnosed with anterior uveitis of unknown etioogy on treatment presented with upper abdominal pain and shortness of breath of six month duration. Physical examination is significant for left sided pleural effusion. CT scan of abdomen and chest revealed multiple pulmonary nodules, hilar, mediastinal lymphadenopathy and moderate left sided pleural effusion with splenomegaly. Thoracentesis revealed hemorrhagic pleural effusion which was exudative in character with T lymphocyte predominance. Cytology and infective work up was negative for malignancy and infections respectively. Lung tissue obtained by Video Assisted Thoracoscopic Surgery showed non- Caseating granuloma and negative for AFB and fungal stains. Patient was started on steroids and the pleural effusion resolved.

DISCUSSION: Sarcoidosis affects people of all racial and ethnic groups and occurs at all ages, although it usually develops before the age of 50 years, with the incidence peaking at 20 to 39 years. African Americans are three times more affected than caucasians. Women are more susceptible than men. Prevalence of pleural involvement in Sarcoidosis varies based on geographical location. Review of Chinese articles reported that the incidence rates of pleural effusion range from 3.4% to 16.7% where as in United states it is less than 3%. Soskel and Sharma reviewed 4833 cases of Sarcoidosis and found pleural effusion in only 37 cases. They described pleural effusions are usually on right side, small to moderate in size and lymphocytic predominant. Pleural effusion in Sarcoidosis is due to capillary permeability and possible explanation for hemorrhagic effusion is due to compression of the vessels by the granuloma The incidence of pleural involvement in Sarcoidosis are higher if follow up is based on CT scan rather than CXR. All pleural effusions in Sarcoidosis are not due to Sarcoidosis, other causes should be evaluated. Pleural effusion in Sarcoidosis may resolve spontaneously (1 to 3 months) or require corticosteroids for resolution (2 weeks). Apart from the present case, to the best of our knowledge, only four cases of hemorrhagic pleural effusion secondary to Sarcoidosis have been published in the literature

CONCLUSIONS: Hemorrhagic pleural effusion due to Sarcoidosis is rare

1) Curr Opin Pulm Med 2000, 6:455-468

2) Chest May 2001 119:5 1547

3) Ann Thorac Med. 2009 Jan;4(1):27-31

DISCLOSURE: The following authors have nothing to disclose: Ramakrishna Chakilam, Vishal Poddar, Mallika Godasi, Prema Madhuri Pamireddy, Alicia Thomas, Octavius Polk

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