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An unusual case of sarcoidosis


Pollock, E; Studer, I; Gisler, V; Samaras, Panagiotis (2013). An unusual case of sarcoidosis. In: SGIM Jahresversammlung, Congress Center Basel, 29 May 2013 - 31 May 2013.

Abstract

Case report A 42-year-old male patient with sarcoidosis, hepatitis C, COPD and previous substance abuse attended routine follow-up in May 2011. Sarcoidosis had been diagnosed in 2002 based on a clinical picture of weakness, relapsing fever, generalized lymphadenopathy, dyspnoea and myalgia together with a lymph node biopsy showing typical granulomas. Tuberculosis had been excluded. In March 2010, the disease had been stable, with stationary findings of hilar lymphadenopathy and reduced diffusion capacity. In May 2011 the patient felt well but reported mild neck and shoulder pain for the past two months and a new skin lesion on the left lateral chest wall. Chest x-ray showed numerous additional lesions up to 1.5 cm in diameter (Figure 1), and a CT chest was performed (Figure 2). This confirmed multiple pulmonary nodules which were consistent with, but not typical for, sarcoidosis. Two weeks later he developed intense neck pain and mild tetraparesis. MRI showed a space-occupying lesion with destruction of the C2 vertebra and spinal cord compression (Figure 3). We carried out a biopsy, which revealed a diffuse large B-cell non-Hodgkin’s lymphoma stage IV AE with IPI risk score 3 (high-intermediate). Following surgical decom-pression and six cycles of R-CHOP chemotherapy, the weakness resolved and the patient remains lymphoma recurrence free one year later. His sarcoidosis has never required treatment.

Abstract

Case report A 42-year-old male patient with sarcoidosis, hepatitis C, COPD and previous substance abuse attended routine follow-up in May 2011. Sarcoidosis had been diagnosed in 2002 based on a clinical picture of weakness, relapsing fever, generalized lymphadenopathy, dyspnoea and myalgia together with a lymph node biopsy showing typical granulomas. Tuberculosis had been excluded. In March 2010, the disease had been stable, with stationary findings of hilar lymphadenopathy and reduced diffusion capacity. In May 2011 the patient felt well but reported mild neck and shoulder pain for the past two months and a new skin lesion on the left lateral chest wall. Chest x-ray showed numerous additional lesions up to 1.5 cm in diameter (Figure 1), and a CT chest was performed (Figure 2). This confirmed multiple pulmonary nodules which were consistent with, but not typical for, sarcoidosis. Two weeks later he developed intense neck pain and mild tetraparesis. MRI showed a space-occupying lesion with destruction of the C2 vertebra and spinal cord compression (Figure 3). We carried out a biopsy, which revealed a diffuse large B-cell non-Hodgkin’s lymphoma stage IV AE with IPI risk score 3 (high-intermediate). Following surgical decom-pression and six cycles of R-CHOP chemotherapy, the weakness resolved and the patient remains lymphoma recurrence free one year later. His sarcoidosis has never required treatment.

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Additional indexing

Item Type:Conference or Workshop Item (Other), not refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
04 Faculty of Medicine > University Hospital Zurich > Clinic for Oncology
Dewey Decimal Classification:610 Medicine & health
Language:English
Event End Date:31 May 2013
Deposited On:13 May 2014 16:00
Last Modified:08 Dec 2017 03:37
Publisher:s.n.

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