SESSION TITLE: Pleural Cases
SESSION TYPE: Case Reports
PRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AM
INTRODUCTION: Sarcoidosis is a chronic multi-system disorder of unknown etiology characterized by granulomatous inflammation. Commonly involved organs include lymph nodes, lungs, skin, eyes and heart. Pulmonary involvement is manifested as hilar or mediastinal lymphadenopathy with parenchymal opacities. Pleural effusion and underlying pleural involvement with sarcoidosis is uncommon and is seen in less than 2% of the cases of pulmonary sarcoidosis. We present one of such case.
CASE PRESENTATION: An 80 year old woman with past medical history of biopsy proven pulmonary sarcoidosis and chronic renal insufficiency presented with worsening dyspnea and dry cough of one week duration with associated right sided pleuritic chest pain. She was oxygenating well on room air and her chest exam was compatible with right sided pleural effusion with clear left lung and no signs of congestive heart failure. Imaging of the chest revealed large amount of right sided pleural effusion with normal left side. CT-Chest confirmed the presence of free flowing right sided effusion along with right hilar adenopathy. Left lung parenchyma was found to be clear. Patient underwent right sided thoracentesis and 1300ml of cloudy yellow exudative pleural fluid was removed. Patient did not show any considerable improvement clinically and underwent a repeat thoracentesis after six days. Malignancy was ruled out with cytological analysis including flow cytometry. Fluid was cultured twice and was negative for bacteria, fungi and mycobacterium. Repeat chest CT showed persistent right side large pleural effusion, two low density masses in right upper and lower lobe and right hilar adenopathy. Patient underwent right VATS for pleural biopsy, partial decortication and talc pleurodesis. Cytological analysis of right pleural biopsy and pleural peel showed diffuse non-caseating granulomatous inflammation with lymphocytic inflammation suggestive of sarcoidosis. Infectious etiology was ruled out with negative acid-fast stain for Mycobacteria or GMS and PAS/LG stains for fungi. Patient showed considerable improvement and was discharged on oral prednisone. A repeat CT-Chest after a month of her discharge confirmed the absence of any significant pleural effusion.
DISCUSSION: Pleural involvement leading to pleural effusion is an uncommon finding. Review of literature shows a 0.7 to 2% incidence of pleural effusion in patients with sarcoidosis. Pleural effusion in sarcoidosis is more common on right side and is usually exudative in character with lymphocytic predominance.
CONCLUSIONS: Pleural effusion is a rarely seen manifestation of sarcoidosis. Most cases exhibit a favorable clinical response to corticosteroid therapy and a good prognosis.
Reference #1: Bloody pleural effusion--a rare manifestation of sarcoidosis. Hou G, Wang W, Zhao YB, Su XM, Wang QY, Li ZH, Kang J.
Reference #2: Rare manifestations of sarcoidosis in modern era of new diagnostic tools. Sharma SK, Soneja M, Sharma A, Sharma MC, Hari S.
DISCLOSURE: The following authors have nothing to disclose: Deepankar Sharma, Joshua Rubenfeld
No Product/Research Disclosure Information