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A 66-year-old man who had been given a clinical diagnosis of vasculitis at another hospital after presenting with high fever and rash was admitted to our hospital for further examination following a relapse of fever during steroid reduction. The biopsy specimens of the leg with crusts showed the presence of epithelioid granuloma, and because of a negative tuberculin test, increased serum angiotensin converting enzyme (ACE) and lysozyme levels, and pulmonary Ga uptake, the patient was given a diagnosis of sarcoidosis. Although the patient had been treated on an outpatient basis following resolution of fever with NSAIDs and 5 mg prednisolone (PSL), he suffered acute respiratory failure during follow-up and required emergency admission. Chest CT revealed bilateral ground-glass opacity and pleural effusion, and serum ACE and soluble IL2R levels were significantly elevated. We diagnosed acute exacerbation of sarcoidosis and given high dose steroid therapy. The patient's symptoms, image findings, blood test results, and other findings promptly improved. Here we reported a highly unusual presentation of acute respiratory failure in sarcoidosis.

A 68-year-old woman was diagnosed as having empyema on the left side. She had a history of pulmonary tuberculosis and tuberculous pleurisy in 1949. She was treated with artificial pneumothorax and implantation of 7 Lucite-ball plombs in the left upper thorax. A chest radiograph taken 14 years after initial operation, revealed an increase in density inside some of the Lucite-ball plombs. She was again admitted after experiencing fever and dyspnea 48 years after initial operation. The chest radiograph then showed a large mass on the left side, which compressed the mediastinum to the right. Inside the mass, Lucite-ball plombs were detected. The fever and inflammatory findings were improved with antibiotic therapy, but the dyspnea was persistent. The Lucite-ball Plombs and coagulating tissue were removed successfully. The patient's symptoms and respiratory function improved after the second operation.