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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Case Report

Pulmonary Sarcoidosis Presenting with Miliary Opacities

Author(s): Omar Arar*, Fabrizio Boni, Tiziana Meschi and Claudio Tana

Volume 15, Issue 1, 2019

Page: [81 - 83] Pages: 3

DOI: 10.2174/1573405614666180806141415

Price: $65

Abstract

Background: Lung lesions often appear in patients with sarcoidosis; however, miliary opacities are rare. We present the case of a 55-year-old Indian man who presented with dyspnea and low-grade fever.

Discussion: Miliary Tuberculosis (TB) was initially suspected, despite the direct microscopic examination from bronchoalveolar lavage was negative for acid-fast bacilli because imaging showed miliary opacities, and transbronchial lung biopsy revealed the presence of typical caseating granulomas. Antitubercular treatment with the classic four-drug regimen was initiated. However, the patient did not improve and cultures were negative for Mycobacterium growth. The diagnosis of sarcoidosis was made only after a negative culture and clinical and histopathological re-evaluation of the case.

Conclusion: Although miliary sarcoidosis is rare, physicians should consider sarcoidosis in the differential diagnosis with conditions like tuberculosis, malignancy, and pneumoconiosis when patients present with miliary opacities who do not respond to the traditional treatment.

Keywords: Pulmonary sarcoidosis, miliary, granuloma, tuberculosis, lung lesions, Mycobacterium.

Graphical Abstract

[1]
Govender P, Berman JS. The diagnosis of sarcoidosis. Clin Chest Med 2015; 36(4): 585-602.
[2]
Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007; 357(21): 2153-65.
[3]
Silva. Imaging of the chest. Elsevier. Philadelphia 2008. Br J Radiol 2008; 82(978): 527.
[4]
Dempsey OJ, Paterson EW, Kerr KM, Denison AR. Sarcoidosis. BMJ 2009; 339: b3206.
[5]
Greco FG, Spagnolo P, Muri M, et al. The value of chest radiograph and computed tomography in pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31(2): 108-16.
[6]
Silva M, Nunes H, Valeyre D, Sverzellati N. Imaging of sarcoidosis. Clin Rev Allergy Immunol 2015; 49(1): 45-53.
[7]
Wessendorf TE, Bonella F, Costabel U. Diagnosis of sarcoidosis. Clin Rev Allergy Immunol 2015; 49(1): 54-62.
[8]
Taki M, Ikegami N, Konishi C, et al. Pulmonary sarcoidosis presenting with miliary opacities. Intern Med 2015; 54(19): 2483-6.
[9]
Statement on sarcoidosis. Joint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS board of directors and by the ERS executive committee, February 1999. Am J Respir Crit Care Med 1999; 160(2): 736-55.
[10]
Rossi G, Cavazza A, Colby TV. Pathology of Sarcoidosis. Clin Rev Allergy Immunol 2015; 49(1): 36-44.
[11]
Binesh F, Halvani H, Navabii H. Systemic sarcoidosis with caseating granuloma 2012.http://casereports.bmj.com/content/2012/bcr.05.2011.4278.abstract
[12]
Tana C, Wegener S, Borys E, et al. Challenges in the diagnosis and treatment of neurosarcoidosis. Ann Med 2015; 47(7): 576-91.
[13]
Bostantzoglou C, Samitas K, Gkogkou C, Zervas E, Gaga M. Mediastinal widening and miliary chest radiograph pattern in a middle aged man: could it be sarcoidosis? 2014.http://casereports.bmj.com/content/2014/bcr-2014-204884.abstract
[14]
Chokoeva AA, Tchernev G, Tana C, Ananiev J, Wollina U. Sarcoid-like pattern in a patient with tuberculosis. J Biol Regul Homeost Agents 2014; 28(4): 783-8.
[15]
Tana C, Tana M, Mezzetti A, Schiavone C. Sarcoidosis: Old certainties and new perspectives. Ital J Med 2012; 6(3): 186-94.
[16]
Hatzakis K, Siafakas NM, Bouros D. Miliary sarcoidosis following miliary tuberculosis. Respiration 2000; 67(2): 219-22.
[17]
Tchernev G, Chokoeva AA, Tana M, Tana C. Transcriptional blood signatures of sarcoidosis, sarcoid-like reactions and tuberculosis and their diagnostic implications. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33(3): 5030.
[18]
Tchernev G, Chokoeva AA, Tana C, Patterson JW, Wollina U, Lotti T. Sarcoid sine sarcoidosis? A classificative, semantic and therapeutic dilemma. J Biol Regul Homeost Agents 2015; 29(1)(Suppl.): 33-4.
[19]
Du SS, Zhao MM, Zhang Y, et al. Screening for differentially expressed proteins relevant to the differential diagnosis of sarcoidosis and tuberculosis. PLoS One 2015; 10(9): e0132466.
[20]
Dhooria S, Gupta N, Bal A, et al. Role of Xpert MTB/RIF in differentiating tuberculosis from sarcoidosis in patients with mediastinal lymphadenopathy undergoing EBUS-TBNA: A study of 147 patients. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33(3): 258-66.
[21]
Blankley S, Graham CM, Turner J, et al. The transcriptional signature of active tuberculosis reflects symptom status in extra-pulmonary and pulmonary tuberculosis. PLoS One 2016; 11(10): e0162220.
[22]
Promteangtrong C, Salavati A, Cheng G, Torigian DA, Alavi A. The role of positron emission tomography-computed tomography/magnetic resonance imaging in the management of sarcoidosis patients. Hell J Nucl Med 2014; 17(2): 123-35.
[23]
Larici AR, Glaudemans AW, Del Ciello A, Slart RH, Calandriello L, Gheysens O. Radiological and nuclear medicine imaging of sarcoidosis. Q J Nucl Med Mol Imaging 2018; 62(1): 14-33.
[24]
Cozzi D, Bargagli E, Calabrò AG, et al. Atypical HRCT manifestations of pulmonary sarcoidosis. Radiol Med (Torino) 2018; 123(3): 174-84.
[25]
Tana C, Iannetti G, D’Alessandro P, Tana M, Mezzetti A, Schiavone C. Pitfalls of Contrast-Enhanced Ultrasound (CEUS) in the diagnosis of splenic sarcoidosis. J Ultrasound 2013; 16(2): 75-80.

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