[Sarcoidosis presenting after successful treatment for Cushing syndrome].
A 37-year-old woman was referred to our department because of an abnormal shadow on her chest radiograph as well as multiple subcutaneous nodules on both her lower legs. She had had a history of Cushing syndrome due to right adrenal adenoma, which was successfully treated by unilateral adrenalectomy two years before her admission to our department; however, the chest radiographic abnormalities and the skin lesions were not apparent at that time. According to our findings, her chest CT showed bilateral hilar and mediastinal lymphadenopathy, irregular thickening of bronchovascular bundles, interlobular septal thickening, and centrilobular micronodules. Skin biopsy specimens demonstrated noncaseating epithelioid cell granuloma, which was consistent with the diagnosis of sarcoidosis. An elevated angiotensin-converting enzyme level and increased accumulation of gallium-67 citrate in the pulmonary parenchyma and hilar lymph nodes also supported the diagnosis. She received no further steroid therapy for the sarcoidosis, and the clinical findings have been improving. In this case, we speculate that sarcoidosis might have been exacerbated by a reduction in the endogenous steroid levels after the unilateral adrenalectomy for Cushing syndrome. We should be aware of the possibility of the condition that steroid-responsive immune diseases such as sarcoidosis might be unmasked and develop after successful treatment for Cushing syndrome.
Tanaka
Kyoko
K
Department of Pulmonary Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
Morishima
Yuko
Y
Ishii
Yukio
Y
Sakamoto
Tohru
T
Suzuki
Hiroaki
H
Otsuka
Fujio
F
Hizawa
Nobuyuki
N
D000315:Adrenalectomy; D000328:Adult; D003480:Cushing Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D012507:Sarcoidosis / Q000209:etiology*