A Case of Pulmonary Sarcoidosis with Acute Respiratory Failure

Abstract

A 27-year old male had blurred vision caused by bilateral urevitis 1 month before admission. He had left supraclavicular and bilateral hillar lymphadenopathy 10 days before. Biopsy of suparaclavicular lymph node was performed five days before, which revealed sarcoid nodules. From the night before his admission he had productive cough and progressive dyspnea and was admitted urgently due to acute respiratory failure with PaO₂ 54.5mmHg. His chest x-ray showed diffuse consolidations with bilateral hillar lymphadenopathy. His chest HRCT showed diffuse ground glass opacities and bilateral pleural effusions. He underwent BAL and TBLB on the first day of admission. Lymphocytes increased and CD4/CD8 ratio was elevated in BALF. TBLB revealed non-caseous epitheloid cell granulomas in the alveolar septa. He immediately received corticosteroid pulse therapy with mPSL of one gram for three days immediately under the diagnosis of acute respiratory failure caused by pulmonary sarcoidosis. He recovered dramatically and pulmonary infiltrates disappeared immediately after the treatment. He had no organ involvement of sarcoidosis except the eyes, lymph nodes and lungs. With no medication for maintenance after mPSL pulse he has had no relapse so far. We reported a rare case of pulmonary sarcoidosis with acute respiratory failure.