Acute alveolar sarcoidosis presenting with hypoxaemic respiratory failure

BMJ Case Rep. 2014 Apr 30:2014:bcr2013202247. doi: 10.1136/bcr-2013-202247.

Abstract

Alveolar sarcoidosis is a less commonly seen pulmonary manifestation of the disease. An acute presentation of this radiological pattern with hypoxaemic respiratory failure has been documented only once, four decades ago. A 30-year-old man presented with acute onset of progressive and persistent dyspnoea over 20 days ago with hypoxaemic respiratory failure. Imaging demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities having ill-defined margins along with air bronchograms in the mid and lower zones bilaterally, suggestive of alveolar sarcoidosis. A restrictive pattern with a diffusion defect was seen on pulmonary function testing. Bronchoscopic evaluation revealed non-caseating granulomas on histopathology confirming pulmonary sarcoidosis. This was further supported by an elevated serum ACE level and negative Mantoux test. Oral prednisolone elicited a rapid clinical and radiological response. Alveolar sarcoidosis can rarely present acutely with hypoxaemic respiratory failure, which can respond remarkably and expeditiously to appropriate therapy.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Biopsy, Needle
  • Bronchoscopy / methods
  • Contrast Media
  • Diagnosis, Differential
  • Follow-Up Studies
  • Humans
  • Hypoxia / diagnosis
  • Immunohistochemistry
  • Male
  • Prednisolone / therapeutic use*
  • Radiographic Image Enhancement
  • Radiography, Thoracic / methods
  • Rare Diseases
  • Respiratory Insufficiency / diagnosis*
  • Sarcoidosis, Pulmonary / diagnosis*
  • Sarcoidosis, Pulmonary / drug therapy*
  • Severity of Illness Index
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome

Substances

  • Contrast Media
  • Prednisolone