Bloody Pleural Effusion -A Rare Manifestation of Sarcoidosis

Abstract

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. Pleural effusion is rare in patients with sarcoidosis, occurring in 0.7% to 20% of cumulative series. Bloody pleural effusion is even more rare. We herein report two cases of sarcoidosis with bloody pleural effusion and discuss the clinical manifestations, diagnostic procedures and treatment of these cases. Sarcoidosis should be included in the differential diagnosis when bloody pleural effusions are detected. An increased level of lymphocytes and an increased ratio of CD4+/CD8+ lymphocytes in bronchoalveolar lavage fluid (BALF) are helpful for making a diagnosis of sarcoidosis. Medical thoracoscopy is helpful for determining the definitive diagnosis. Corticosteroids are an effective treatment; however, the dose should be individualized according to the treatment response.

Acute Pleuritis in Sarcoidosis

“…Rarely, haemorrhagic, chylous and eosionphilic effusions have been reported. 2,6,[10][11][12][13][14] Pleural thickening has also been reported in about 33% of patients on chest computed tomography (CT), mostly in patients with pulmonary fibrosis. 15 To the best of our knowledge, presence of acute pleuritis in sarcoidosis as seen in our patient has not been described earlier.…”

Pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid: a case report

“…Sarcoidosis can also involve the pleura: pleural sarcoidosis is observed in only 1.1% of out-patients with sarcoidosis [ 3 ] and in approximately 3% of all cases of sarcoidosis [ 4 ]. Pleural sarcoidosis is diagnosed clinically [ 3 , 5 , 6 ] or histologically by thoracoscopy [ 7 , 8 ] or percutaneous pleural biopsy [ 3 , 9 ].…”