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Case Reports in Medicine

Case Reports in Medicine / 2020 / Article / Tab 1

Case Report

Necrotizing Sarcoid Granulomatosis: A Disease Not to be Forgotten

Table 1

Clinical characteristic of the two patients with necrotizing sarcoid granulomatosis. SACE: serum angiotensin-converting enzyme; ACE: angiotensin-converting enzyme; ADA: adenosine deaminase; PCR: polymerase chain reaction; BAL: bronchoalveolar lavage; AFB: acid-fastness; CT: tomography scan; EEG: electroencephalography; NMR: nuclear magnetic resonance; and FNAB: fine needle aspiration biopsy.
 Case 1Case 2
Sex and age24-year-old female. 37 weeks pregnant31-year-old male
Family historyFather diagnosed with discoid lupusBrother diagnosed with sarcoidosis (pulmonary and cutaneous involvement)
PresentationLeft supraclavicular lymphadenopathyPeripheral vertigo, weakness in right lower limb, instability, and sphincter incontinence
Physical examinationApprox. 4 × 4 cm supraclavicular tumour attached to deep planesBradipsychia. Right horizontal nystagmus. Paresis 4+/5 left upper limb and lower limbs. Left extensor cutaneous plantar reflex. Unstable romberg
LaboratoryNo lymphopoenia. T CD4/CD8 lymphocyte ratio: 1.43. Normal SACE. Calcium/phosphorus metabolism: normal. 24 h urine calciuria slightly higher than normal (264 mg/dL).
Positive Mantoux.		Discrete lymphopoenia. T CD4/CD8 lymphocyte ratio: 0.97. High SACE. Calcium/phosphorus metabolism: normal. Calciuria in urine at 24 h: normal.
Positive Mantoux.
Lumbar puncture: High ACE and ADA.
Cultures (including fungi) and indian ink: negative.
Sputum culture and mycobacterial PCR: negative.
BAL and sputum samples: negative for AFB
Imaging testsCervical CT scan, lymphadenitis that does not suggest pyogenic origin.
Chest x-ray: normal.		EEG: delta activity, more frequent on the right side.
Brain NMR: meningeal uptake that extends to the cervical area.
Chest CT scan: mediastinal nodules and bronchoalveolar infiltrates in both bases
Anatomical pathologyFNAB supraclavicular adenopathy: necrosis and granulomas. PCR mycobacterium tuberculosis: negative.
Ganglion exeresis: chronic lymphadenitis with sarcoid granulomas (Figure 1)		Open lung biopsy: necrotizing granulomatous infiltrates. PCR mycobacterium tuberculosis: negative