MULTISYSTEMIC SARCOIDOSIS: AN UNUSUAL PRESENTATION

Abstract

TYPE: Case Report TOPIC: Pulmonary Manifestations of Systemic Disease INTRODUCTION: Sarcoidosis is a chronic multisystemic disease characterized by noncaseating granulomas which affects the pulmonary system and intrathoracic lymph nodes most frequently. Pleural and renal involvement in sarcoidosis is rare. CASE PRESENTATION: A 34 year old African American female with presented with progressively worsening shortness of breath. Of note, this was her fourth hospitalization in six months. Her first presentation was for flank pain. Workup revealed a renal infiltrative process and a left sided pleural effusion. Kidney biopsy was significant for noncaseating granulomas. A right lower lobe pulmonary embolus (PE) was diagnosed on her second admission and recurrent left sided pleural effusions were noted on the third and fourth admissions. Hepatic infiltrative hypodensities in the liver were visualized. Angiotensin converting enzyme level was 137 U/L. On her final presentation, bronchoscopy demonstrated a stereotypical cobblestone appearance and transbronchial lymph node biopsy demonstrated non-necrotizing granulomatous disease. DISCUSSION: Most cases of sarcoidosis tend to affect the lungs, however, both pleural effusion or granulomatous interstitial nephritis (GIN) as a presenting symptom of the disease is uncommon. Pleural involvement is sarcoidosis occurs in 0.7-10%. Clinically relevant GIN is identified in 0.5-0.9% of native kidney biopsies making it a rare histological diagnosis. With workup for other pathology being negative, sarcoidosis was assessed as the cause for the unique clinical course of this patient with biopsy proven pleural and renal disease, and possible hematologic, ocular, and hepatic involvement. CONCLUSIONS: Clinicians must maintain a high level of suspicion for sarcoidosis in patients with multisystemic disease, due to the potential for atypical presentations. DISCLOSURE: Nothing to declare. KEYWORD: Sarcoidosis