Abstract
We present the case of a young male who visited the emergency room with progressive dys pnea and left sided chest pain. A chest X-ray was performed which showed a pattern of diffuse nodular and reticular opacities. The diagnosis of Necrotizing Sarcoid Granulomatosis (NSG) was made by histopathological examination of a lung biopsy specimen and by exclud ing other causes of granulomatous disease. He was treated with corticosteroids. Because of persistent extrapulmonary (ocular) involvement a maintenance dose of prednisone was needed. Necrotizing Sarcoid Granulomatosis is a granulomatous disease with necrosis and vasculitis of unknown cause. The resemblance between NSG and (nodular) sarcoidosis is strong, but subtle differences exist. The prognosis is good and therapy is usually not necessary. However in some cases there is a need for therapy with corticosteroids, depending on the involved organs and/or the degree of impairment.
Highlights
CASE PRESENTATIONA 21 year old non-smoking male was presented at the emergency department of our hospital
We present the case of a young male who visited the emergency room with progressive dyspnea and left sided chest pain
There were no complaints that could be related to a vasculitis-like disease, e.g. vision problems, joint aches, skin problems or abdominal discomfort
Summary
A 21 year old non-smoking male was presented at the emergency department of our hospital He suffered from pain in his right shoulder and on the left side of his chest, with progressive shortness of breath for two days. Antinucleair antibodies (ANA) and anti-neutrophil cytoplasmatic antibodies (ANCA) were both negative Analysis of his urine showed no abnormalities. We started with a dose of 60 mg of prednisone a day and gradually tapered the dose till zero, over a period of six months With this regime complete recovery was achieved, with normalization of his chest X-ray. After seven months he developed a sicca like syndrome of the eye He was examined by an ophthalmologist and an octreotide scan was performed, the diagnosis of dacryoadenitis was made. With a maintenance dose of ten milligrams he is free of symptoms for a year
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