Necrotizing Sarcoid Granulomatosis With Pleural Involvement

Chittock, Dean R.; Joseph, Mariamma; Paterson, Nigel A. M.; McFadden, Robin G.

doi:10.1378/chest.106.3.672

Cited by 67 publications

(59 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Lymphadenopathy in NSG is reported in 10-65% of cases [11,12], whereas previous reports in adult [13] and paediatric patients [5] found no hilar or mediastinic lymph node enlargement, as occurred in the current case. No typical laboratory and radiographic/functional findings can be of help in diagnosing NSG.…”

Section: Discussioncontrasting

confidence: 81%

“…The erythrocyte sedimentation rate was elevated in this patient, a finding present in some [9], but not all papers in the literature [6]. Pulmonary function tests showed a restrictive pattern, as in other previous cases [5,11], but this finding is not universal [4,6]. The CD4+/CD8+ ratio in the peripheral blood of the current patient was normal; however, in a previous case [6] this value was reported to be reduced early in the disease, but later normalised.…”

Section: Discussionsupporting

confidence: 69%

“…The typical radiographic findings with NSG are single or multiple lung opacities [10], with common involvement of the pleura [5,11], as was observed in this case (figs 2a and b). Lymphadenopathy in NSG is reported in 10-65% of cases [11,12], whereas previous reports in adult [13] and paediatric patients [5] found no hilar or mediastinic lymph node enlargement, as occurred in the current case.…”

Section: Discussionsupporting

confidence: 64%

“…In addition, 5% of patients with sarcoidosis show histological characteristics typical of NSG [3,20]. Hilar lymphadenopathy and extrapulmonary manifestations are more frequent in sarcoidosis [11,15], as is the presence of an elevated serum angiotensin-converting enzyme (ACE) level. In the present case, ACE could not be assessed, but in most of the previously reported cases of NSG [4][5][6]13] it was in the the normal range.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A 13-year-old female with shortness of breath and pleuritic chest pain

Aliberti

Falleni

Tarsia

et al. 2006

European Respiratory Journal

View full text Add to dashboard Cite

A 13-yr-old Caucasian female was referred to the Dept of Paediatric Diseases (Havana, Cuba) with shortness of breath and pleuritic chest pain located in her right hemithorax. The pain had occurred the day before while doing physical activity and lasted ,1 h. The patient reported a 2-month history of recurrent episodes of pleuritic chest pain, which were either self-limited or relieved by paracetamol, as well as growing fatigue in the previous few weeks. Her past history was remarkable for a diagnosis of pneumonia after exposure to fumigation during a dengue haemorrhagic fever epidemic 2 yrs earlier, which was treated with steroids and antibiotics.On admission, the patient had no weight loss, no fever or dyspnoea. Physical examination showed decreased breathing sounds in the inferior part of both hemithoraces. Cardiovascular, abdominal and neurological examination, as well as ear, nose and ophthalmologic investigations were unremarkable. The chest radiograph showed bilateral pneumonia with moderate right-sided pleural effusion. The leukocyte count was 9.8610 9 cells?L -1 with 54% neutrophils and 32% lymphocytes. The erythrocyte sedimentation rate was 85 mm?h -1 . Serum chemistry, renal and liver function tests were in the normal range. Blood cultures were negative. Antibiotic therapy with ceftriaxone and amikacin was started. During the treatment the patient reported 2 days of moderate fever and various episodes of left-sided pleuritic chest pain, which occurred especially during forceful diaphragm contractions (i.e. sneezing, laughing and coughing).Following a short stay in the Cuban hospital, the patient was transferred to an Italian hospital (Como). Amikacin was discontinued and clarithromycin added. A new chest radiograph ( fig. 1), 14 days after the previous one, and a computed tomography (CT) scan of the thorax were performed. Echocardiography and abdominal ultrasound were both negative. An increased value of the tumour marker CA-125 (220 U?mL -1 , versus a normal value ,35 U?mL -1 ) was found. Microbiological and blood testing workup results are shown in table 1.After 1 week, the patient was admitted to a hospital in Milan where a thoracic CT scan ( fig. 2) and whole-body positron emission tomography (PET; fig. 3) were performed. The latter was obtained in order to identify any possible extrapulmonary focus of the disease. Further microbiological and blood testing is shown in table 1.Pulmonary function tests showed a restrictive ventilatory pattern with a total lung capacity 76% of predicted, a vital capacity of 2.66 L (75% pred), a forced expiratory volume in one second of 2.43 L (82% pred), a transfer factor of the lung for carbon monoxide of 6.52 mmol?min -1 ?kPa -1 (71% pred) and a transfer coefficient of the lung for carbon monoxide of 1.83 mmol?min -1 ?kPa -1 ?L -1 (94% pred).Fibreoptic flexible bronchoscopy did not reveal any endobronchial lesion. Cultures of bronchoalveolar lavage (BAL) for bacteria, including Mycobacterium tuberculosis, and for fungi, and a search for malignant cells were negative...

show abstract

Section: Discussioncontrasting

confidence: 81%

Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A 13-year-old female with shortness of breath and pleuritic chest pain

Aliberti

Falleni

Tarsia

et al. 2006

European Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…Since then, several case reports have documented the existence of NSG, mainly reporting lung involvement. 1,[3][4][5][6][7][8][9][10] The etiology and pathogenesis are still unknown.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Sarcoid Granulomatosis With an Uncommon Manifestation: Clinicopathological Features and Review of Literature

et al. 2013

View full text Add to dashboard Cite

We report a rare case of an incidental diagnosis of necrotizing sarcoid granulomatosis (NSG) in a 60-y-old non-smoking male. The patient was admitted to the hospital for sudden back pain. Chest x-ray revealed areas of parenchymal consolidation and high-resolution computed tomography demonstrated a pulmonary nodular pattern with no lymph node enlargement. All laboratory and pulmonary function tests were normal. Bronchoscopy with bronchoalveolar lavage showed no sign of infection or specific inflammation. The diagnosis of NSG was made by histopathological examination of a surgical lung biopsy and by excluding other causes of granulomatous disease. In paucisymptomatic/asymptomatic patients, as in our case, therapy is not necessary, with a good prognosis and complete recovery. NSG is a rare systemic disease similar to sarcoidosis and Wegener's granulomatosis with a benign clinical course and should always be considered for patients with nodular pulmonary lesions even with subclinical or uncommon features.

show abstract