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Obstructive Lung Diseases |

Initial Presentation of Sarcoidosis in the Very Elderly: Report of Two Cases

Hemantkumar Raval, MD; Craig Thurm, MD; Alan Fein, MD; Kelly Cervellione, MA; Bhargav Patel, MD; Carolina De Elia
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Jamaica Hospital Medical Center, Jamaica, NY


Chest. 2013;144(4_MeetingAbstracts):670A. doi:10.1378/chest.1705125
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Abstract

SESSION TITLE: Interstitial Lung Disease Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

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

INTRODUCTION: Sarcoidosis is most common in African-Americans between 20 and 40 years of age. Ninety percent of sarcoidosis patients will present with some form of lung disease, which may be asymptomatic. Sarcoidosis in elderly patients greater than 80 years is unusual, accounting for <1% of cases. We present two cases of initial presentation of sarcoidosis in very elderly patients, an 89-year-old asymptomatic woman diagnosed incidentally and an 86-year-old symptomatic woman with both pulmonary and ocular sarcoidosis.

CASE PRESENTATION: Case 1: An 88-year-old never smoking African-American female with multiple comorbidities including hypertension and diabetes presented with right leg cellulitis. Physical examination was otherwise normal without any skin, eye, cardiovascular or CNS findings. She denied any respiratory symptoms. Chest x-ray revealed pulmonary nodular infiltrates. PFTs revealed restriction. CT chest confirmed mediastinal lymphadenopathy with nodular infiltrates. Endobronchial and transbronchial biopsies showed non-caseating granulomas, confirming a diagnosis of sarcoidosis. Case 2: An 86-year-old white female with multiple comorbidities including breast cancer status-post mastectomy and radiotherapy 13 years prior presented with dyspnea on exertion associated with chest pain. Complete cardiac work-up including echo, stress test and pulmonary function tests failed to reveal cause of symptoms. CT of the chest showed significant mediastinal lymphadenopathy. PET scan showed diffuse hypermetabolic lesions in mediastinal and supraclavicular lymph nodes. EBUS and follow-up biopsy of the precarinal lymph node revealed non-caseating granulomas. Her symptoms initially improved with steroids, though she relapsed with both systemic symptoms and right 6th nerve palsy, thought to be secondary to sarcoidosis.

DISCUSSION: Here we report on two patients who were initially diagnosed with sarcoidosis in their late 80s. A very small percentage of patients with sarcoidosis present in the elderly or very elderly, while the majority of patients present under the age of 40. There is a female predominance in these elderly patients. They usually presents with anorexia, fatigue, cough and dyspnea. Diagnosis may be challenging in the elderly, especially in light of other common diagnoses more frequently seen in the aging population such as malignancy and CHF. Treatment is also likely to be more complicated; steroid-related adverse effects are usually higher in elderly.

CONCLUSIONS: A diagnosis of sarcoidosis should not be discounted solely because of advanced age, especially in patients with consistent clinical and radiographic findings.

Reference #1: Lodha S, Sanchez M, Sarcoidosis of the skin: a review for the pulmonologist. Chest 2009; 136:583.

Reference #2: Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007; 357:2153.

DISCLOSURE: The following authors have nothing to disclose: Hemantkumar Raval, Craig Thurm, Alan Fein, Kelly Cervellione, Bhargav Patel, Carolina De Elia

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