Sarcoidosis

Case contributed by Dr Henry Knipe

Presentation

Cough

Patient Data

Age: 30 years
Gender: Male
X-ray

Bilateral hilar and mediastinal lymphadenopathy. Left lower lobe airspace opacity. Right lung is clear. No pleural effusion.

CT

Bilateral paratracheal and hilar lymphadenopathy. Left lower lobe consolidation. Right lower lobe patchy consolidation with ground glass opacity. Patchy nodular opacities throughout the remainder of the lungs.

The patient underwent percutaneous ultrasound-guided right supraclavicular node biopsy.

Histopathology

MICROSCOPIC DESCRIPTION: Sections show a lymph node replaced by non-necrotizing granulomas composed of epithelioid histiocytes with occasional multinucleated giant cells, interspersed by a lymphocytic infiltrate. No necrosis is identified. The ZN, Gram and PAS special stains are negative for micro-organisms.

DIAGNOSIS: Non-necrotizing granulomatous inflammation consistent with sarcoidosis. 

Case Discussion

Bilateral hilar and paratracheal is almost classic for sarcoidosis. The pulmonary changes are less typical although sarcoidosis is a known mimicker and has a heterogeneous pulmonary appearance. 

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