Abstract Introduction Sarcoidosis is a rare multisystem granulomatous disease with heterogeneous presentation in the pediatric population. Here, we present a case of a 12-year-old boy who presented with non-specific symptoms concerning for malignancy or infection, ultimately diagnosed with sarcoidosis. Case Our patient is a 12-year-old male who presented in October 2024 with bilateral eye redness, swelling, and discharge for which he was prescribed multiple rounds of steroid-containing eye drops without improvement. He re-presented in December 2024 with rapidly enlarging bilateral neck swelling, continued blephoritis, dyspnea, nasal discharge, and a 5lb weight loss. Due to concern for malignancy, he was referred to the emergency department where work-up was notable for an elevated WBC count and uric acid. He was admitted to general pediatrics and additional labs including anti-LA, anti-RO, ANA, rheumatoid factor, Mumps IgM, and C4 were obtained which were all normal. Given his stable clinical appearance, he was discharged with planned ophthalmology, immunology, and rheumatology follow-up. In late December 2024, he was seen by allergy-immunology and infectious disease where further work-up, including QuantiFERON Gold, toxoplasma, and HIV, was negative. ENT also performed flexible laryngoscopy which revealed no masses or polyps. A CT was obtained in January 2025, which showed “diffuse enlargement of bilateral parotid and submandibular glands” as well as “nodules in visualized apical lungs”. A biopsy of the right parotid gland was performed which revealed non-necrotizing granulomatous inflammation and a few IgG4 plasma cells, raising suspicion for an inflammatory disorder such as sarcoidosis. In April 2025, he was seen by rheumatology who felt that sarcoidosis was the most likely diagnosis given clinical presentation and prior negative work-up. After discussion with the pulmonology team, a high-resolution CT scan was obtained which showed numerous small, non-calcified pulmonary nodules as well as mediastinal lymph node enlargement (Figure 1). He was started on methotrexate and prednisone with subsequent decreased parotid swelling and a 3kg weight gain. In August 2025, he was seen by pulmonology with PFTs demonstrating normal spirometry, slightly low TLC, and normal DLCO. Currently, he is without systemic symptoms and continues his prednisone wean with plans for repeat lung function testing once off steroids. Discussion This case highlights an unusual presentation of pediatric sarcoidosis with bilateral parotid gland swelling. Additionally, it underscores the importance of a multidisciplinary approach in diagnosis and management as systemic involvement, such as pulmonary findings, may be present on imaging even in the absence of significant clinical symptoms. This abstract is funded by: None
Giammattei et al. (Fri,) studied this question.