Review Question - QID 100833

The clinical presentation in this vignette is most likely sarcoidosis. Biopsy of the lung in this patient would show non-caseating granulomas.

Sarcoidosis is a systemic granulomatous disease involving young and middle-aged adults. The cause is yet unknown. Patients may present with bilateral hilar lymphadenopathy, pulmonary infiltrates, and ocular and skin lesions. While noncaseating granulomas are the histopathological hallmark of sarcoidosis, they also are nonspecific.

Wu et al. review the diagnosis and prognosis of sarcoidosis. Currently, the diagnosis is based on clinical and radiographic findings plus histologic evidence of noncaseating epithelioid granulomas. Because noncaseating granulomas are not specific to sarcoidosis, other granulomatous diseases must be excluded. Prognosis correlates with mode of onset, host characteristics, initial clinical course, and extent of disease.

Iannuzzi et al. provide a detailed overview of the pathogenesis and presentation of sarcoid, including histologic findings. Sarcoidosis can involve nearly every organ system presenting as neurologic disease, uveitis, blindness, end-stage pulmonary fibrosis, pulmonary hypertension, dysrhythmias, cardiomyopathy, hypercalcemia, and renal failure. It can be very disabling, resulting in chronic disease in approximately one-third of cases.

Illustration A displays a non-caseating granuloma as in sarcoidosis. Illustration B depicts an overview of what can be seen in a patient with sarcoidosis.

Incorrect Answers:
Answer 1: Persistent inflammation, fibrosis, and cyst formation that is most prominent in subpleural regions most likely represents idiopathic pulmonary fibrosis.
Answer 2: Silica particles (birefringent) surrounded by collagen most likely represent silicosis.
Answer 3: Golden-brown fusiform rods most likely represent asbestos bodies.
Answer 4: Patchy interstitial lymphoid infiltrate into walls of alveolar units most likely represents rheumatoid lung disease.