[Uncommon manifestation revealing sarcoidosis].
BACKGROUND
Bilateral hilar lymphadenopathy, with or without lung parenchymal infiltrates, is the most common radiographic finding in patients with sarcoidosis. Atypical pulmonary findings have been uncommonly reported and include multiple large lung nodules, cavitation, lobar collapse, pleural effusions or pneumothorax.


METHODS
We report a 21-year-old non caucasian patient who presented with pulmonary nodular infiltration and sinonasal involvement revealing sarcoidosis. Thoracic and sinus computed tomographic scan showed both multiple excavated large lung nodules and micronodules, hilar lymphadenopathy and sinus thickening. Laboratory studies disclosed elevated angiotensin converting enzyme serum level (120UI/L). Outcome was favorable after institution of corticosteroids (at an initial dose of prednisone of 1mg/kg/day); at eight-month-follow-up, the patient was asymptomatic, while receiving prednisone 22.5mg/day.


CONCLUSIONS
In patients exhibiting unusual pulmonary manifestations, diagnosis of sarcoidosis relies on compatible clinical signs, evidence of non-caseating granulomas, and exclusion of underlying conditions including infections, malignancy and other granulomatous diseases (Wegener disease, pneumoconiosis).
Département de médecine interne, CHU de Rouen-Boisguillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
G
G
Armengol
J
J
Bernet
L
L
Lahaxe
H
H
Lévesque
I
I
Marie
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging; D010254:Paranasal Sinus Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests; D012507:Sarcoidosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D011241:Prednisone
Un mode de révélation inhabituel de la sarcoïdose.