SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Sarcoidosis is a systemic inflammatory disease characterized by granuloma formation with a prevelance of 10-20 per 100,000 people, more commonly found in blacks. Sarcoidosis most frequently involves the lung but can manifest in any organ system to a varying degree(1,2). Here we present a patient with a history of Gilbert’s found to have new splenic lesions initially thought to have malignancy. CASE PRESENTATION: A 38-year-old male, never smoker, with a history of Gilbert’s disease and hepatitis as an infant was referred to our pulmonary clinic for suspected sarcoid. The patient is polish in origin and lived in southern Poland during the Chernobyl event then moved to the United States (US) shortly after, has remained in the US since. He had an outpatient MRI with and without contrast of the abdomen for elevated liver function tests showing splenomegaly with multiple scattered lesions in the spleen concerning for lymphoma for which he was referred to hematology. At his hematology visit he reported some weight loss, nocturnal fevers and night sweats, laboratory results at that time revealed an elevated ACE level of 222, ESR 28, no anemia or leukopenia, marked elevation of polyclonal IgG as well as elevation of kappa and lambda chains but normal ratio. He was deemed to not have lymphoma and was referred to pulmonary for sarcoid work up. In our clinic pulmonary function testing was normal. PET/CT scan revealed multiple active lymph nodes (LNs) both above and below the diaphragm, most of which are not abnormally enlarged on CT. The most active lesion was a left external iliac node (SUVmax 16). Biopsy of the left external iliac LN showed no evidence of sarcoid. Bronchoscopy was then pursued with transbronchial biopsies of right upper lobe which showed multiple noncaseating epithelioid granulomas, Langhans giant cells, lymphocytes and Asteroid bodies, with no sign of malignancy. The patient also had an ophthalmic evaluation with no findings of sarcoid and negative infectious work up. The patient was diagnosed with sarcoidosis with pulmonary and splenic involvement. DISCUSSION: Sarcoid is usually expected to present with pulmonary involvement but multiple splenic lesions can be the initial presentation. Systemic symptoms of fatigue, malaise, weight loss, and fever are nonspecific and can easily be confused with symptoms of malignancy(3). Approximately 6% of sarcoid patients have splenomegaly on physical exam with 15% of patients having hypodense splenic nodules on CT(1,4). Other signs to look for are hypersplenism resulting in anemia, leukopenia, thrombocytopenia, or pancytopenia which our patient did not have(5). CONCLUSIONS: It is important to have a broad deferential when approaching a patient with splenic lesions. Assessment for signs suggestive of systemic sarcoid is necessary to avoid missed or delayed diagnosis. Reference #1: Warshauer DM, Dumbleton SA, Molina PL, Yankaskas BC, Parker LA, Woosley JT. Abdominal CT findings in sarcoidosis and clinical correlation. Radiology 1994; 192: 93-9 Reference #2: Thomas KW, Hunninghake GW. Sarcoidosis. JAMA. 2003;289(24):3300–3303. https://doi.org/10.1001/jama.289.24.3300 Reference #3: Raber EL, Haba J, Beck P. Splenic sarcoidosis: a case report and review of the imaging findings of multiple incidental splenic lesions as the initial presentation of sarcoidosis. Can J Gastroenterol. 2011;25(9):477-8. DISCLOSURES: No relevant relationships by Ajay Adial, source=Web Response No relevant relationships by Asma Iftikhar, source=Web Response No relevant relationships by Tereza Izakovich, source=Web Response no disclosure on file for Stephen Karbowitz