Pulmonary Sarcoidosis Presenting with Thin-walled Small Cysts.

A 32-year-old man was admitted due to a persistent dry cough and an abnormal chest shadow. Chest computed tomography (CT) revealed multiple thin-walled small cysts, in addition to a ground-glass appearance and small, irregular-edged nodules along the bronchovascular bundles and sub-pleural parenchyma (Picture A). The patient's serum levels of lysozyme (13.3 U/mL) and soluble interleukin-2 receptor (609 U/mL) were elevated, while his angiotensin-converting enzyme levels were normal. The patient was diagnosed with pulmonary sarcoidosis based on the evidence of non-caseating epithelioid cell granulomas in the biopsied lung tissue (Picture B) and the detection of Propionibacterium acnes-specific monoclonal antibody by immunohistochemistry (1) (Picture C). Twelve years after the initial diagnosis, the number of thin-walled cysts of the lung increased on high-resolution CT (Picture D), and despite having never smoked, there was a slight decline in his respiratory function. Cysts, bullae, and emphysema have been reported as atypical features in patients with pulmonary sarcoidosis, but their pathogenesis remains unknown. This is a rare case of pulmonary sarcoidosis presenting with thin-walled small cysts, rather than large cysts, as has been reported in previous studies (2).

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The authors state that they have no Conflict of Interest (COI).