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A6528 - Recurrent Sarcoidosis Resembling Splenic Malignancy
Author Block: H. Alkhankan1, E. Alkhankan2, H. Mezughi3, M. A. Megri3, H. S. Bukamur2, A. Amro3, F. Alkhankan4, F. M. Zeid2; 1Pulmonary Critical Care medicine, Mercy hospital/ Saint Louis University, St. Louis, MO, United States, 2Pulmonary Medicine, Marshall University, Huntington, WV, United States, 3Internal Medicine, Marshall University, Huntington, WV, United States, 4Pulmonary / Critical Care Medicine, McLaren Oakland, Pontiac, MI, United States.
Introduction:
Sarcoidosis is a multi-system disease characterized by granuloma formation that can affect any organ and it has a varied presentation. Rarely, sarcoidosis presents with isolated splenic involvement as primary or reactivation of the disease. We present a patient who was found to have isolated splenic sarcoidosis as a reactivation of the disease.
Case presentation:
A 66-year-old, non-smoking, female presented with none productive cough for several months and has a history of sarcoidosis. Five years ago, she presented with bilateral pulmonary nodules and mediastinal adenopathy, which was confirmed at that time by a fine needle aspiration (FNA) under endobronchial ultrasound biopsy (EBUS), revealing non-caseating granulomatous inflammation. She was treated with a course of steroids and her previous yearly chest CT showed remission of her disease. On this presentation, she was found to have incidental multiple splenic masses on a CT scan of the chest. Physical examination was nonocclusive and she had negative tests for tuberculosis, rheumatologic disease, systemic sclerosis, and mixed connective tissue disease. Pulmonary function tests were consistent with restrictive impairment and mild decrease in diffusion capacity for carbon monoxide. Positron Emission Tomography (PET scan) showed increase uptake corresponding to these lesions with no other areas of abnormal uptake in the body. CT-guided biopsy of splenic lesion showed non-caseating granulomas consistent with sarcoidosis. She was retreated with a course of steroids and a follow up CT scan of the abdomen showed resolution of the splenic masses.
Discussion:
Sarcoidosis is a systemic inflammatory disorder of unknown etiology characterized by non-caseating granulomas. Any organ can be involved; however, the involvement of abdominal viscera is rare and less frequent than pulmonary or mediastinal disease. Visceral involvement is usually asymptomatic and presents as hepatosplenomegaly, but rarely as focal hepatosplenic nodular lesions. When visceral sarcoidosis occurs, it may mimic infectious or neoplastic conditions that may have similar morphology, such as tuberculosis, histoplasmosis, and lymphomas. Differential diagnosis also may include other benign conditions, such as hemangiomas and hamartomas. Diagnosis is usually confirmed by a biopsy and remission of the disease after steroid treatment is seen in over 70% of patients in the literature with low recurrence rates. Reactivation usually occurs with pulmonary and mediastinal involvement. This is rarely limited to the spleen.
Conclusion:
Sarcoidosis can affect any organ, although this rarely occurs after several years with quiescent disease course. Reactivation of the disease can be limited to the spleen, resembling splenic malignancy.