Sarcoidosis as a diagnostic challenge – a case report

Abstract

Sarcoidosis is considered a disease of unknown etiology which usually affects several organs and systems of the body and is manifested by the development of non-caseous granulomas. It is predominantly a multisystemic granulomatous disease that most often affects the respiratory and lymphatic systems, but varies clinically from patient to patient, making it difficult to diagnose correctly. The diagnosis is based on clinical and radiological data, the results of the sarcoidosis biomarker examinations, confirmed by the histological picture of non-caseous epithelioid cell granulomas. The use of modern instrumental methods of examination such as magnetic resonance imaging, high-resolution computed tomography, 18F-fluorodeoxyglucose-positron emission tomography has significantly improved the diagnosis of sarcoidosis.

Aim. The purpose of this paper is to present a clinical case of pulmonary sarcoidosis with atypical initial origin needed for additional differentiation and specific confirmation of the diagnosis.

Materials and methods. Diagnostic and differential diagnostic procedures were provided for a 24-year-old patient at the Therapeutic Department of the Regional Hospital of War Veterans (Chernivtsi, Ukraine). Complete examination included general clinical, laboratory and instrumental testing. Results of the clinical data were analyzed in dynamics, clinical diagnosis was confirmed by specific biomarkers, imagine tests and transbronchial lung biopsy with histology.

Results. The authors have presented the case of the 24-year-old man with atypical sarcoidosis associated with vertebrogenic thoraco-lumbalgia and persistent severe pain syndrome. He was admitted due to fever, increased temperature up to 37.2–37.4 °C, headache, muscular thoracic spine pain, unexplained general intoxication. He had a history of nephrectomy and mine-explosive injury. His specific objective findings were negative, but some nonspecific inflammatory biomarkers were imbalanced. Respiratory and inflammatory manifestations worsened in several days after admission that led to further diagnostic search and raised suspicion of sarcoidosis. Given the nonspecific clinical presentation and laboratory findings, the diagnosis needed a confirmation by chest computed tomography, sarcoidosis biomarkers and transbronchial lung biopsy with histology.

Conclusions. Thus, this case illustrates that even classic pulmonary sarcoidosis may started atypically, and diagnostic procedure requires extensive differentiation and specific confirmation by using modern diagnostic tools.