Clinical Crossroads | Clinician's Corner

A 47-Year-Old Woman With Sarcoidosis

Steven E. Weinberger, MD, Discussant
JAMA. 2006;296(17):2133-2140. doi:10.1001/jama.296.17.2133.
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Ms K, a 47-year-old woman, was found to have sarcoidosis after evaluation of an abnormal chest radiograph obtained during work-up of a recently diagnosed melanoma. She has symptoms of fatigue, achiness, and exertional dyspnea. She believes her symptoms are due to sarcoidosis and would like to get some symptomatic improvement, though she is reluctant to be treated with corticosteroids. She is interested in knowing about the likely course of her disease and the potential treatment options. The various presentations, protean manifestations, variable natural history, and attempts to understand the etiology of sarcoidosis are discussed. The principles underlying the decision of whether to institute treatment, the options for treatment, and the effectiveness of treatment are reviewed.

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Figure 1. Cross Section of Chest Computed Tomographic Image From Ms K
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The image demonstrates several small, poorly defined nodules in a bronchovascular distribution, primarily in the right upper lung field. The arrowhead points to one of these nodules.

Figure 2. Photomicrograph of Lung Biopsy From Ms K
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The image demonstrates confluent noncaseating granulomas with multinucleated giant cells (hematoxylin and eosin stain, original magnification × 60). Reproduced with permission from the Department of Pathology, Beth Israel Deaconess Medical Center.

Figure 3. Chest Radiographic Images of Stage 1 and Stage 4 Sarcoidosis
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Left, chest radiographic image of stage 1 sarcoidosis shows bilateral hilar and mediastinal adenopathy without parenchymal lung disease. Right, chest radiographic image of stage 4 sarcoidosis shows diffuse parenchymal lung disease with fibrosis, more prominent in the upper lung zones.




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