This case illustrates the evolution of pulmonary sarcoidosis in its fibrotic-cicatricial stage along the years, culminating with bilateral spontaneous pneumothoraces as a sequela of advanced bullous disease: emphysematous bleb or necrosis of a subpleural sarcoid granuloma 1. The patient has a confirmed diagnosis of sarcoidosis and has been followed up by the respiratory clinic along the last 10 years, now in consideration for a lung transplant.
In about 20% of patients, sarcoidosis evolves to prominent lung fibrosis as in this case. Note that the fibrocystic changes have a predominant upper and middle zones distribution 1.