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[Subcutaneous nodules, mediastinal and hilar lymphadenopathy].

Authors :
Li YY
Zhang T
Gao L
Xu WB
Tian XL
Zhu YJ
Liu HR
Peng M
Shi JH
Feng R
Source :
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases [Zhonghua Jie He He Hu Xi Za Zhi] 2022 Apr 12; Vol. 45 (4), pp. 387-391.
Publication Year :
2022

Abstract

A 52-year old man was admitted to our hospital because of dyspnea on exertion for 2 months and subcutaneous nodules for 1 month. Chest enhanced CT showed bilateral hilar and mediastinal lymphadenopathy. Bronchial alveolar lavage fluid revealed a CD <subscript>4</subscript> <superscript>+</superscript> /CD <subscript>8</subscript> <superscript>+</superscript> T cell subsets ratio of 4.3 and culture for acid-fast bacillus (AFB) was negative. The pathology of skin nodules and transbronchial needle aspiration biopsy guided by endoscopic ultrasound (EBUS-TBNA) revealed non-caseating necrotizing epithelioid granulomas with negative acid-fast bacilli staining and periodic acid-Schiff staining, which was compatible with sarcoidosis. The patient was diagnosed as sarcoidosis and glucocorticoid was administrated. The subcutaneous nodules were improved. However, the lymph nodes were enlarged instead of shrinking after 6-month therapy. The failure to respond to glucocorticoids raised the possibility of sarcoidosis complicated with tuberculosis infection. The patient received anti-tuberculosis therapy. Lymphadenopathy responded within 4 months, and there was complete regression after 18-month treatment. The patient was followed up for 5 years and repeated chest CT scan showed that the sizes of bilateral hilar and mediastinal lymph nodes were normal.

Details

Language :
Chinese
ISSN :
1001-0939
Volume :
45
Issue :
4
Database :
MEDLINE
Journal :
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases
Publication Type :
Academic Journal
Accession number :
35381637
Full Text :
https://doi.org/10.3760/cma.j.cn112147-20210929-00688