Abstract
A 26-year-old asymptomatic male was referred to our department for detailed investigation of abnormal chest shadows. Chest X-ray film on admission revealed bilateral hilar lymphadenopathy and cotton like shadows in both lung fields. Systemic lymphadenopathy and swelling of bilateral parotic glands was detected, and small nodules were palpable in the muscles of the upper extremities. There was a small nodule on the left lower lip. Serum ACE level was 44.5 U/ml. Ga scintigram showed no abnormal accumulation in the upper extremities. Bronchoscopic findings showed redness and vascular dilatation of the mucosa, but no characteristic findings of sarcoidosis such as yellow plaques. Pathological findings obtained by transbronchial lung biopsy revealed epitheloid granulomas without caseous necrosis. Histologically, the nodular mass in the right bicep muscle was a granuloma composed of epitheloid cells, and showing characteristics of the sarcoidosis without caseous necrosis. It is well known that muscular involvements are common in sarcoidosis, but palpable muscular nodules are very rare. Including our case, 38 cases of sarcoidosis with palpable muscular nodules have been reported in Japan. Bronchoscopic findings included redness, vascular dilatation and yellow plaques. In half of the reported cases, the nodules were in the upper extremities.
