- Necrotizing sarcoid granulomatosis is an infrequent disease.
- It is a rare granulomatous pneumonitis which manifests as sarcoid-like granulomas, variable amount of necrosis and granulomatous vasculitis.
A 38-year-old female patient presented to the hospital with a 3-day history of dyspnoea and chest pain. The patient was admitted on September 19th, 2016. Her medical history did not reveal any skin rash, arthralgia, weight loss or fever. Physical examination showed a pulse rate of 110/70 mmHg, pulse rate 85 and temperature 37.5°C. Her respiratory rate was 28 while she was breathing ambient air. In addition, lung auscultation showed decreased breath sounds in the left lower zone of the lung. All other physical examinations were normal. Doctors diagnosed the patient with necrotizing sarcoid granulomatosis (NSG).
Investigations findings
Chest radiography was remarkable of two pulmonary nodules and basal atelectasis and pneumothorax. CT scan of the chest showed consolidation of the left lower lobe with pneumothorax. In addition, two small-sized cystic lesions were also evident within the collapsed region.
Laboratory tests showed an increase in WBC count. Neutrophils were predominant with elevated erythrocyte sedimentation rate and C-reactive protein. The nitroblue tetrazolium (NTB) blood test was 99% accurate. Tests for anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies (C-ANCA and P-ANCA), and anti-double-stranded DNA (anti-dsDNA) were negative. There were signs of moderate restriction in the pulmonary function tests.
Doctors performed a resection of the two intraparenchymal pulmonary nodules and cavitary lung lesion. Histological examination confirmed the diagnosis of necrotizing sarcoid granulomatosis. Histopathology showed giant cell granulomas, some epithelioid and necrotizing arteritis with a large area of necrosis. NSG generally does not require treatment. However, in some cases, treatment with corticosteroids is recommended. In this case the patient’s symptoms resolved spontaneously.
References
Necrotizing Sarcoid Granulomatosis with Pneumothorax https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589305/
