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Primary Cavitating Pulmonary Sarcoid FREE TO VIEW

Ralitza Martin, MD; Srihari Veeraraghavan, MD; Travis Henry, MD
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Emory University, Atlanta, GA

Chest. 2013;144(4_MeetingAbstracts):911A. doi:10.1378/chest.1702348
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SESSION TITLE: Miscellaneous Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoidodis is a multi-system disease characterized by granulomatous formations. The lung is affected in 90% of the cases and the most common manifesations are bilateral hilar adenopathy, lung infiltrates or nodules. Primary cavitating pulmonary sarcoid is a very rare presentation of sarcoidosis with an estimated prevalence of 2% and only a few case reports can be found in the literature.

CASE PRESENTATION: 42 year old African American female with no significant medical history presented for a second opinion for an unresolving left lower lobe (LLL) infiltrate. She reports that 6 months prior she was admitted to another hospital with acute respiratory failure. Imaging revealed LLL opacity and she was treated for pneumonia. After several courses of antibiotics her symptoms and the radiologic findings did not improve. She underwent bronchoscopy with biopsy which showed non-caseating granulomas, all cultures (including fungal and AFB) were negative. Patient was then referred for further evalution. On repeat imaging it was evident that she now had LLL cavitation in addition to bilateral hilar lymphadenopathy (LAD). Autoimmune work up was negative. Bronchoscopy was repeated but biopses of the hilar lymph nodes and the new cavitary lesion showed again granulomas and no evidence of infection. She continued to complain of progressive dyspnea. Eight months after her initial presentation she underwent thoracoscopic LLL lobectomy and lymph node biopsy which confirmed again non-caseating granulomas. All cultures remained negative which confirmed the final diagnosis of primary cavitating sarcoid. She was placed on systemic steorids with improvement of symptoms and is now closely followed in clinic.

DISCUSSION: Sarcoidosis is a disease of so far unknown etiology that can affect any organ but the lung is most commonly involved. There is no specific test for sarcoidosis but histopathologic evidence of non-caseating granulomatous inflammation is key. Successful treatment with systemic steroids has been reported.

CONCLUSIONS: Primary cavitating sarcoid is an extremely rare presentation of pulmonary sarcoidosis but should be considered in the evaluation of cavitating lung lesions after excluding other causes such as infection, malignancy or auto-immune.

Reference #1: Medicine (Baltimore). 2008 May;87(3):142-51. doi: 10.1097/MD.0b013e3181775a73. Pulmonary cavitary sarcoidosis: clinico-radiologic characteristics and natural history of a rare form of sarcoidosis. Hours S, Nunes H, Kambouchner M, Uzunhan Y, Brauner MW, Valeyre D, Brillet PY.

Reference #2: Nihon Kokyuki Gakkai Zasshi. 2000 Dec;38(12):952-7. Three cases of primary acute pulmonary cavitation in sarcoidosis Asai Y, Nakayama T, Furuichi S, Kobayashi T, Hashimoto S, Horie T.

Reference #3: June 1980, Volume 134, Number 6 Primary acute pulmonary cavitation in sarcoidosis PK Rohatgi and LE Schwab

DISCLOSURE: The following authors have nothing to disclose: Ralitza Martin, Srihari Veeraraghavan, Travis Henry

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