A Case of Sarcoidosis Manifesting as Acute Polyarthritis and Fever

Abstract

A 28-year-old man had suffered bilateral pain and swelling in the elbows, wrists, knees and ankles as well as fever for about one month. Polyarthritis was diagnosed, based on the clinical symptoms and inflammatory changes. The serum C-reactive protein level was 10.9mg/dl, and the erythrocyte sedimentation rate was 25mm/hour. The patient's chest X-ray films revealed small nodular shadows in the bilateral upper lung fields in addition to hilar lymphadenopathy. The signs and symptoms suggested sarcoidosis, pulmonary tuberculosis or pulmonary eosinophilic granuloma. The serum angiotensin converting enzyme (ACE) level was 19.1IU/L, and an ophthalmologic study did not suggest sarcoidosis. However, bronchoalveolar lavage fluid obtained by fiberoptic bronchoscopy revealed an increased number of total cells, increased lymphocytic proportion and elevated CD4/CD8 ratio (8.31). A histological study of specimens obtained by transbronchial lung biopsy revealed non-caseating epithelioid cell granuloma. Based on these findings, the sarcoidosis was diagnosed. Chest X-ray films taken 6 months before admission showed no abnormality. Those taken after one month of follow-up showed increased lung involvement and exacerbated hilar lymphadenopathy and at that time, the serum ACE level increased to 32IU/L. The patient's polyarthritis improved following treatment with naproxen. This case indicates that sarcoidosis should be considered as a possible cause of polyarthritis.