PULMONARY AND SPLENIC SARCOIDOSIS MIMICKING LYMPHOMA

Abstract

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Sarcoidosis is a chronic multisystem disease of unknown etiology. It is characterized by noncaseating granulomas mainly involving lungs but any organ might be affected. As a diagnosis of exclusion extrapulmonary sarcoidosis might be challenging to diagnose based on the site of involvement. Here a case of pulmonary and splenic Sarcoidosis is presented that was mimicking lymphoma (1). CASE PRESENTATION: 51 Y.O F with PMH of ADHD, beta thalassemia, morbid obesity, former smoker stopped 15 years ago and left hip OA s/p replacement was referred to pulmonary clinic for abnormal CT findings. Physical exam was benign and she did not have any active complaints. CT chest was remarkable for multiple bilateral nodular and ground glass opacities measuring up to 5-6 mm, mild diffuse mediastinal and bilateral hilar lymphadenopathy measure up to 47 x 18 mm with focal low density changes suggestive of cystic or necrotic components. CT abdomen revealed enlarged spleen with multiple hypodense lesions measuring up to 21 mm and a stable left renal cyst. Labs were noticeable for Normal ACE level, microcytic anemia, negative quantiferon, normal LDH and the rest were unremarkable. Lymphoma and sarcoidosis at this time were on the top of differential diagnosis list. Bronchoscopy was done with EBUS and transbronchial biopsy revealed noncaseating granulomatous inflammation suggestive of sarcoidosis with no evidence of malignancy. With impression of pulmonary and extra pulmonary sarcoidosis she was started on prednisone. 4 months later patient stopped the prednisone on her own since she was gaining weight so she was stared on methotrexate. Interval changes were followed with CT imaging that was significant for resolution of some of the pulmonary opacities with no increase in the size of remaining. Mediastinal and hilar lymphadenopathy resolved and size of lesions in spleen decreased. Patient remained asymptomatic and is still following up for further management. DISCUSSION: In more than 90 % of patients with sarcoidosis pulmonary involvement was reported. Ocular, lymph-node, and cutaneous findings are the more frequent involved organ systems respectively. more than 50% of cases has co existing pulmonary and extra pulmonary manifestations while only 2% of patients present with isolated extra pulmonary sarcoidosis (2). Prednisone is considered the first-line therapy. Side effects of chronic steroid use and lack of response are limiting factors that can cause significant morbidity in long term treatments. Steroid sparing treatments are increasingly used in these instances. Methotrexate is the disease-modifying antisarcoid drugs that is usually used by most sarcoidosis experts (3). CONCLUSIONS: Extra pulmonary sarcoidosis is mainly coexistent with pulmonary disease. lymphoma is on the differentials with splenic and lymph node involvement and biopsy is needed to confirm and exclude the other possibilities. Reference #1: Baughman RP, Teirstein AS, Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001;164(10 Pt 1):1885–1889. Reference #2: Valeyre D, Prasse A, Nunes H, Uzunhan Y, Brillet PY, Müller-Quernheim J. Sarcoidosis. Lancet. 2014;383(9923):1155–1167. Reference #3: Korsten P, Mirsaeidi M, Sweiss NJ. Nonsteroidal therapy of sarcoidosis. Curr Opin Pulm Med. 2013;19(5):516–523. DISCLOSURES: No relevant relationships by Jonathan Arnedo, source=Web Response No relevant relationships by Sara Khademolhosseini, source=Web Response No relevant relationships by Seyedmohammad Pourshahid, source=Web Response No relevant relationships by Theo Trandafirescu, source=Web Response