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Nodular Splenic Sarcoidosis: A Rare Case Report and Review of the Literature FREE TO VIEW

Mustafa Calik, MD; Murat Aygun, MD; Mihrican Yesildag, MD; Saniye Calik, MD; Ceyhan Ugurluoglu, MD; Mustafa Cayci, MD; Taha Bekci, MD; Hidir Esme, MD
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Department of Thoracic Surgery, Konya Education and Research Hospital, Konya, Turkey

Chest. 2014;146(4_MeetingAbstracts):399A. doi:10.1378/chest.1993635
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SESSION TITLE: ILD Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoidosis is a chronic multisystemic disorder of unknown aetiology characterized by an accumulation of epithelioid granulomas without caseation necrosis in affected organs. Even though it can affect every organ system, pulmonary involvement is the most frequent manifestation. Abdominal involvement is diagnosed by imaging modalities in 5-15% of the patients [1,2]. The most common abdominal computed tomography (CT) findings of sarcoidosis are enlargement of spleen and liver, and lymphadenopathy. A rare abdominal manifestation is multiple hypodense nodular lesions involving both the liver and the spleen [2]. Here; we presented a rare and usually asymptomatic case with splenic sarcoidosis without liver involvement

CASE PRESENTATION: A 31-year-old male patient admitted to our clinic with cough, sputum and shortness of breath. On admission, the only positive finding on physical examination was bilateral diffuse rhonchus. He denied experiencing common systemic complaints of sarcoidosis including fatigue, fevers, arthritis, visual changes or rashes. His medical history showed no evidence of spleen, liver or infectious diseases; and no special medication had been taken. Thorax and abdominal CT showed multipl hypodense mediastinal lymph nodes and splenic involvement. ACE level was high. No other intra-abdominal pathology and peripheral lymphadenopathy was found. Diagnostic bronchoscopy was performed with biopsies. Transbronchial biopsy was normal. Considering the patient had sarcoidosis and underwent a mediastinoscopy for diagnosis. Sarcoidosis was diagnosis histopathologically. Medical therapy was started. After this treatment patient's complaints were decreased

DISCUSSION: Sarcoidosis commonly represent with bilateral hilar lymphadenopathy, pulmonary infiltration with characteristic radiographic findings and ocular or skin lesions. Nodular splenic involvements are uncommon. Even though; there have been reported thirty-nine cases of sarcoidosis with multiple nodular hepatic and splenic lesions, only three isolated splenic cases have been reported in the literature.Because of its rarity and seldom accepted as sarcoidosis in splenic nodules; extra-pulmonary sarcoidosis such as gastrointestinal involvement when present can cause significant morbidity and mortality [1,3].

CONCLUSIONS: Physicians and radiologists should be aware of this. Therefore, we discussed this case to draw attention to splenic sarcoidosis without liver and its manifestations, diagnosis, and clinical course.

Reference #1: Warshauer D. M. Splenic Sarcoidosis Seminars in Ultrasound, CT and MRI 2007 Feb; 28(1):21-27

Reference #2: Thanos L, Zormpala A, Brountzos E, Nikita A, Kelekis D. Nodular hepatic and splenic sarcoidosis in a patient with normal chest radiograph. Eur J Radiol. 2002 Jan;41(1):10-1.

Reference #3: Chen MY, Cai JT, Du Q, Wang LJ. Sarcoidosis of spleen presenting with solitary thrombopenia. Eur J Intern Med. 2009 Jan; 20(1):e12.

DISCLOSURE: The following authors have nothing to disclose: Mustafa Calik, Murat Aygun, Mihrican Yesildag, Saniye Calik, Ceyhan Ugurluoglu, Mustafa Cayci, Taha Bekci, Hidir Esme

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