Pleuropulmonary sarcoidosis with pleural effusion as the first manifestation: a case report and review of literatures

Abstract

Objective \nTo improve the recognition of pleuropulmonary sarcoidosis (PPS) with pleural effusion as the first manifestation and reduce the rate of misdiagnosis and missed diagnosis. \n \n \nMethods \nA case of PPS with pleural effusion as the first manifestation was retrospectively reviewed.The particularity of this case was analyzed in combination with domestic and foreign literatures. \n \n \nResults \nThe patient was a middle-aged woman while cough and shortness of breath after exercise was her main clinical symptoms.Chest radiographs revealed pleural effusion.The patient was admitted to hospital with diagnosis of the nature of pleural effusion to be examined . After admission, the patient received closed thoracic drainage, chest computed tomography (CT), positron emission tomography (PET)/CT, but the diagnosis was still not clear.Subclavian lymph node biopsy showed proliferative granulomatous lesions.Combined with imaging and lymph node biopsy, the diagnosis was confirmed.Symptoms and imaging improved after hormone therapy. \n \n \nConclusions \nPPS with pleural effusion as the first manifestation is relatively rare.It has nonspecific clinical symptoms, no characteristic physical and chemical properties of pleural effusion.The pathological and physiological basis of PPS is lung parenchyma, pleural non-caseous granuloma infiltration.The diagnosis needs to rely on pleural and pulmonary (bronchial) tissue biopsy.But for some hospitals unable to carry out medical thoracoscopy or fiberoptic bronchoscopy biopsy, superficial enlarged lymph node biopsy is also a feasible diagnostic method, and PET/CT plays an important role in the diagnosis of PPS. \n \n \nKey words: \nPleuropulmonary sarcoidosis;\xa0Pleural effusion;\xa0Biopsy