Sarcoidosis Presenting With Cystic Lung Lesions and Autoimmune Hemolytic Anemia

Abstract

Introduction Hemolytic anemia is an unusual finding in sarcoidosis. We report an intriguing case of hemolytic anemia in cystic sarcoidosis. Case Presentation A 34-year-old African American male with bronchial asthma presented with wheezing, exertional dyspnea, cough, fever, night sweats, weight loss, and fatigue. Physical examination revealed pallor, palpable peripheral adenopathy, and expiratory rhonchi. Initial laboratory findings were remarkable for leukopenia, anemia, reticulocytosis, elevated lactate dehydrogenase, and abnormal liver function test. Serum haptoglobin was low. Sickling test was negative. Direct Coombs test was positive, and cold agglutinins were demonstrated. Chest radiograph revealed cystic lesions in both upper lung fields, and chest computed tomographic scan confirmed these lesions. Also seen were mediastinal adenopathy and hepatosplenomegaly. Tuberculin skin test was negative in 48 hours. Three sputum smears for acid-fast bacilli were negative. Serum angiotensin converting enzyme level was elevated. He underwent diagnostic bronchoscopy with carinal and transbronchial lung biopsies revealing non-necrotizing granulomatous inflammation consistent with sarcoidosis. Acid-fast bacilli and silver stains were negative. Respiratory and lung tissue cultures were negative for fungi and Mycobacteria. Diagnosis of sarcoidosis with autoimmune hemolytic anemia was established and systemic corticosteroid was instituted with resolution of hemolysis and modest roentgenographic regression of the cystic lung lesions. Conclusions Some cases of cystic/bullous sarcoidosis had been reported and the occurrence of autoimmune disease with sarcoidosis well known. To the best of our knowledge, this is the first reported case of sarcoidosis presenting with cystic lung lesions and autoimmune hemolytic anemia in a single patient.