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Diffuse Lung Disease |

Delayed Diagnosis of Sarcoidosis in Patient With Asthma-like Symptoms

Raluca Geamalinga; Ionela Belaconi; Stefan Dumitrache-Rujinski; Claudia Toma; Miron Alexandru Bogdan
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National Institute of Pneumology "Marius Nasta" Bucharest Romania, Bucharest, Romania


Chest. 2014;145(3_MeetingAbstracts):227A. doi:10.1378/chest.1836448
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Abstract

SESSION TITLE: ILD Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Sarcoidosis is a multisystem inflammatory disorder.Usually the diagnosis is sugestted by clinical symptoms and chest radiography, but further investigations are required. Sometimes the diagnosis is difficult, especially when patient presents with interstitial lung syndrome.

CASE PRESENTATION: We present the case of a 65 years old nonsmoker female diagnosed two years previous with so called "asthma" (obstruction on spirometry but without reversibility and effort dyspnea improved with short courses of corticotherapy). She was admitted in our clinic with dyspnea at rest, with respiratory failure (SaO2 of 81% while breathing ambiant air), weight loss (15 kg in 6 months), nasal dryness and xerostomy, in which clinical examination showed perioral cyanosis, and bilateral pulmonary wheezing. Chest radiography revealed left pleural effusion and diffuse micronodular lung opacities, mainly in the lower lobes. pulmonary function tests showed mild mixed ventilatory dysfunction and decreased DLco (2.76 L). Bronchoscopy with BAL showed no proliferation and lymphocytosis with normal CD4/CD8 ratio on BAL. Ziehl-Neelsen stain was negative for AFB. CT scan showed left pleural effusion, "ground glass" and micronodular infiltration in peribronhovascular and subpleural spaces, isolated adenopathies with maximum axial diameters of 1.3 cm pretracheal, right latero-tracheal, the right hilum and retrocarinal. Also we performed a salivary gland biopsy that was nondiagnostic. thoracotomy with lung biopsy found numerous sarcoid type granulomatous lesions with epithelioid and giant cells, without necrosis, with moderate interstitial fibrosis with lymphocytic infiltration. The diagnosis of type II sarcoidosis was made and systemic corticotherapy was started with good clinical, functional and imaging outcome.

DISCUSSION: Sarcoidosis diagnosis may be delayed because of inconsistency between symptoms, associated diseases, clinical and imaging data, which may require attention because it can be easily overlooked.

CONCLUSIONS: Case of sarcoidosis in patient with asthma-like symptoms, treated for a long period of time only for obstructive symptoms due to sarcoidosis lesions of the bronchi or obstructive syndrome associated to sarcoidosis.

Reference #1: 1

DISCLOSURE: The following authors have nothing to disclose: Raluca Geamalinga, Ionela Belaconi, Stefan Dumitrache-Rujinski, Claudia Toma, Miron Alexandru Bogdan

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