Pulmonary Manifestations of Systemic Disease: Systemic Disease |

Annular Cavitary Pulmonary Sarcoidosis: A Rare Presentation FREE TO VIEW

Ravi Paul Singh Virdi, MD; Renli Qiao, MD
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University of Southern California, Los Angeles, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A467. doi:10.1016/j.chest.2016.02.486
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SESSION TITLE: Systemic Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Sarcoidosis is a systemic granulomatous disorder affecting people of all races, with incidence peaking at 20 to 39 years. Sarcoidosis is a multi-organ process but lung involvement is present in upto 90% cases. Pulmonary sarcoidosis is staged based on lymphadenopathy and interstitial infiltrate. We describe a case presenting with asymptomatic multiple annular lung lesions.

CASE PRESENTATION: A 28 year old female presented with abnormal chest radiograph (CXR) showing centrally lucent masses, one measuring 3.2 cm in left mid lung and another 4.7 in left lower lung. She was asymptomatic and had normal CXR 3 months ago. She admitted significant smoking history plus methamphetamine and alcohol use. She had quit cocaine. The lung examination was negative. Multiple small healed skin lesions seen were attributed to skin picking during methamphetamine use. Sputum cultures had no growth of bacteria, acid-fast bacilli and fungi. Tests for atypical pulmonary pathogens and immunological work up were all negative. Computed tomography revealed multiple bilateral round consolidations, some with central sparing in mid and lower lungs. Bronchoalveolar lavage and trans bronchial biopsies of left lower lobe showed non necrotizing granulomas consistent with sarcoidosis. Patient was offered treatment with corticosteroids but refused. She was followed for 1 year with serial imaging and remained asymptomatic.

DISCUSSION: First called “Mortimer’s Malady” in 1869, sarcoidosis was reported throughout the world. The highest annual incidence (5-40 cases per 100,000) is observed in Northern Europe. The etiology of sarcoidosis remains undetermined and its pathology is characterized by non caseating granulomas in the involved organs. Clinical presentation and outcomes vary widely. Cardinal feature of sarcoidosis is the presence of CD4+ T cells that interact with antigen presenting cells to initiate the formation of granulomas. Cavitary lesions in pulmonary sarcoidosis is extremely rare with prevalence around 2% of all lung manifestations but has been reported. Cavities may be detected on initial presentation or may develop later. The advanced cavities can be complicated by bacterial or fungal infections. Treatment with steroids may lead to resolution of lesions in asymptomatic patients.

CONCLUSIONS: Sarcoidosis should be considered as differential diagnosis in patient with cavitary lung lesions.

Reference #1: Michael C. Iannuzzi, et al. Sarcoidosis. N Engl J Med 2007;357:2153-65.

Reference #2: Hiroshi Tada, et al. Annular lesion of the lung in sarcoidosis. Thorax 1989;44:756-757.

DISCLOSURE: The following authors have nothing to disclose: Ravi Paul Singh Virdi, Renli Qiao

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