SESSION TITLE: Fellow Case Report Poster - Pulmonary Manifestations of Lung Disease
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
INTRODUCTION: Endoluminal stenosis of proximal bronchi (ESPB) is a rare and severe manifestation of pulmonary sarcoidosis.
CASE PRESENTATION: A 42 year old African American gentleman with history of night sweats and wheezing presented to the hospital with sudden onset chest pain due to right sided pneumothorax. CT chest revealed hemorrhagic bullae occupying most of the right middle lobe (RML) with partial collapse of the right upper lobe (RUL) and mediastinal lymphadenopathy. Mediastinoscopy was performed with right middle lobectomy followed by flexible bronchoscopy which revealed 90% stenosis of RUL bronchus, 70% stenosis of the bronchus intermedius (BI) and normal left bronchial tree. Pathology revealed necrotic tissue from RML and non-caseating granulomas from a station 2R lymph node. After an extensive negative workup to rule out other etiologies, the patient was diagnosed with pulmonary sarcoidosis. He was started on 50 mg of prednisone daily followed 6 months later with methotrexate 15 mg weekly. A repeat airway exam at 6 months showed continued stenosis of the RUL bronchus and BI. He was therefore sent for balloon dilation of his BI. Eight months later CT chest revealed partial re-expansion of the RUL collapse.