Case Report

Eosinophilic Pleural Effusion, Peripheral Eosinophilia, Pleural Thickening, and Hepatosplenomegaly in Sarcoidosis

Authors: Evaggelos Vafiadis, MD, Maria S. Sidiropoulou, MD, Vasilios Voutsas, MD, Theodoros L. Giannopoulos, MD, Fotis Iordanidis, MD, Pandora Christaki, PhD, Panagiotis Palladas, MD

Abstract

In this atypical case of sarcoidosis with an unusual combination of clinical and laboratory findings, a 32-year-old male presented with a 3-month history of thoracic pain complicated with dyspnea. Laboratory tests, chest radiography, and CT scans of the chest and abdomen revealed eosinophilia of pleural effusion and blood, pleural thickening, hepatosplenomegaly, and bronchiolitis obliterans. In cases such as this, in which pleural fluid eosinophilia is accompanied by peripheral eosinophilia and splenohepatomegaly, underlying malignancies such as Hodgkin lymphoma should be ruled out. A biopsy of the mediastinal lymph nodes suggested noncaseating epithelioid granulomas, characteristic of sarcoidosis. The patient underwent prednisolone therapy for 1 year and is doing well 2 years after initial diagnosis.


Key Points


* A 32-year-old male had laboratory tests, chest radiograph, and CT scans that revealed eosinophilia of pleural effusion and had blood, pleural thickening, hepatosplenomegaly, and bronchiolitis obliterans.


* Differential diagnosis mainly included lymphoma and sarcoidosis.


* Biopsy of mediastinal lymph nodes was finally performed to determine a definite diagnosis and suggested noncaseating epithelioid granulomas characteristic of sarcoidosis.

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References

1. Soskel NT, Sharma OP. Pleural involvement in sarcoidosis. Curr OpinPulm Med 2000;6:455–468.
 
2. Kuhn M, Fitting JW, Leuenberger P. Probability of malignancy in pleural fluid eosinophilia. Chest1989;96:992–994.
 
3. Durand DV, Dellinger A, Guerin C, et al. Pleural sarcoidosis: one case presenting with an eosinophilic effusion. Thorax 1984;39:468–469.
 
4. Beekman JF, Zimmet SM, Chun BK, et al. Spectrum of pleural involvement in sarcoidosis. Arch Intern Med 1976;136:323–330.
 
5. Nicholls AJ, Friend JAR, Legge JS. Sarcoid pleural effusion: three cases and review of the literature.Thorax 1980;35:277–281.
 
6. Berte SJ, Pfotenhauer MA. Massive pleural effusion in sarcoidosis. Am Rev Respir Dis 1962;86:261–264.
 
7. Schaumann J. Étude anatomo-pathologique et histologique sur les localisations viscérales de la lymphogranulomatose bénigne. Bull Soc Franc Dermat Syph 1933;40:1167–1178.
 
8. Chusid EL, Siltzbach LE. Sarcoidosis of the pleura. Ann Intern Med 1974;81:190–194.
 
9. Wilen SB, Rabinowitz JG, Ulreich S, et al. Pleural involvement in sarcoidosis. Am J Med1974;57:200–209.
 
10. Lum GH, Poropatich RK. Unilateral pleural thickening. Chest 1996;110:1348–1350.
 
11. Hirsch A, Ruftie P, Nebut M, et al. Pleural effusion: laboratory tests in 300 cases. Thorax1979;34:106–112.
 
12. Martinez-Garcia MA, Cases-Viedma E, Cordero-Rodriguez PJ, et al. Diagnostic utility of eosinophils in the pleural fluid. Eur Respir J 2000;15:166–169.
 
13. Rubins JB, Rubins HB. Etiology and prognostic significance of eosinophilic pleural effusions. Chest1996;110:1271–1274.
 
14. Adelman M, Albelda SM, Gottlieb J, et al. Diagnostic utility of pleural fluid eosinophilia. Am J Med1984;77:915–920.
 
15. Light RW. Pleural diseases. Baltimore, MD: Williams & Wilkins,1995, pp 42.
 
16. Renston JP, Goldman ES, Hsu RM, et al. Peripheral blood eosinophilia in association with sarcoidosis. Mayo Clin Proc 2000;75:586–590.
 
17. Brauner MW, Grenier P, Mompoint D, et al. Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology 1989;172:467–471.
 
18. Saito W, Kobayashi H, Shinkai M, et al. [Pulmonary involvement in sarcoidosis: CT findings at diagnosis and their changes at follow-up in cases without corticosteroid treatment]. Nihon Kokyuki Gakkai Zasshi 2002;40:210–214.