A Case of Sarcoidosis Accompanied by Middle Lobe Syndrome

Abstract

A 32-year-old female presented in September 1989 with a 2-month history of cough and white sputum. Chest X-ray film and subsequent CT scanning showed bilateral hilar lymphadenopathy with atelectasis of right middle lobe. Fiberoptic bronchoscopy revealed vascular dilatation of bronchial mucosa and obstruction of right middle lobe orifice with extrinsic bronchial compression. Bronchial biopsy revealed noncaseating granulomas composed of epithelioid cells with Langhans type giant cells compatible with sarcoidosis. Diagnosis was confirmed by transbronchial lung biopsy and right inguinal node biopsy. Three weeks after institution of steroid therapy, bronchial mucosal lesion and obstruction of middle lobe almost totally disappeared. Atelectasis is uncommon in sarcoidosis. There have been only 4 such cases in the previous Japanese literature, However, in cases of atelectasis such as middle lobe syndrome, sarcoidosis must be considered.