Abstract Sarcoidosis is a multisystem granulomatous disorder without a clearly defined pathophysiology or etiology. Pulmonary involvement is common; however, extrapulmonary manifestations are also frequently observed. It is atypical, however, to see cavitary lesions and concurrent lymphocyte-rich loculated pleural effusions as part of pulmonary involvement. We present the case of a 31-year-old female, non-smoker, with pulmonary sarcoidosis and associated extrapulmonary manifestations. She was noted to have an unusual presentation of pulmonary sarcoidosis with cavitary lesions at the initial diagnosis and was later found to have pleural involvement with a lymphocyte-predominant pleural effusion. She was later noted to have an exudative, loculated, left-sided effusion. A chest tube was subsequently placed with minimal output. Given concurrent fever spikes, she underwent decortication of the left lower lobe given suspicion of possible concurrent infection. Microbiological data was subsequently negative. She also exhibited extrapulmonary manifestations, including a history of stomach perforation status post Graham patch repair, micronodular hepatosplenomegaly, cutaneous sarcoid lesions, and ocular sarcoidosis (complaining of blurred vision). Ultimately, she was started on methotrexate with a prednisone bridge, resulting in dramatic improvement of her pulmonary and extrapulmonary sarcoid manifestations. The patient continued on methotrexate and demonstrated a good response with regard to her systemic sarcoid symptoms. Cavitary lesions and pleural effusion occurring independently in sarcoidosis are both rare; their concurrent presentation further adds to the complexity and variability of sarcoidosis. Typically, management of sarcoidosis-associated pleural effusion and cavitary disease involves systemic corticosteroids. Resistant cases have been treated with pleurodesis. In our case, the effusion was not only lymphocyte-rich but also loculated, raising suspicion for an infectious etiology in the context of cavitary lesions. This ultimately led to surgical decortication. This abstract is funded by: None
Syed et al. (Fri,) studied this question.