Rare Presentation of Sarcoidosis

Abstract

Patient: A 54-year-old Caucasian woman with no history of smoking or drinking, no recent trauma, and no occupational exposure to irritants. No known allergies. No history of recent foreign travel. Current Chief Complaint: Dyspnea and chest pain. Past Medical History: Patient presented in 2002 with epigastric pain and fullness after consumption. Tests showed abnormal liver function tests (LFTs). A liver biopsy was non-conclusive. She was referred to the gastroenterologist, who felt that though her LFTs were abnormal, they have been static. Another liver biopsy was not warranted. The patient continued to have abnormal LFTs even though her symptoms improved until February 2006, when she developed pruritus and right upper quadrant (RUQ) pain. In 2003 the patient started presenting with symptoms of hypothyroidism, as she presented with depression weight gain. Testing revealed increased thyroid-stimulating hormone (TSH) and low T3 and T4. The patient began thyroxine. The patient has had severe left knee pain and common extensor pain (tennis elbow) since 2006. Pruritus and night sweats started in 2006 and persisted on and off. Atypical angina, transient ischemic attacks (TIA), left arm weakness, dysarthria, amaurosis fugax-like symptoms (appeared on only 1 occasion), left-sided facial droop, and numbness, began in June 2007 and persisted. Dyspnea has worsened since 2005. No conclusive diagnosis has been reached. Drug Allergies: Aspirin and Salbutamol Current Medications: Prednisolone (7.5 mg daily), Azathioprine (50 mg once daily), Ursodeoxycholic Acid, Atorvastatin, Thyroxine (75 mcg daily), Bisoprolol, Irbesartan, Alendronate, Warfarin, Ventolin. Family History: No significant family history. Social History: Health care assistant. Non-smoker. No alcohol intake. Married and lives with spouse. Physical Exam Vital Signs: Blood pressure, 130/77; temperature, 36.8; weight, 72.6 kgs; BMI, 29. No lymph node enlargement. Chest was clear on auscultation. Normal heart sounds. 1. What are the patient’s most striking (a) clinical, (b) radiological, (c) …