Wud Al-Kailany1,2, Wim Timens3, Ben Venmans4, Gonda de Jonge5, Tjip S van der Werf6,7. 1. Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, AA11, PO Box 30001, 9700 RB, Groningen, The Netherlands. 2. Ziekenhuis Amstelland, Laan van de Helende Meesters 8, 1186 AM, Amstelveen, The Netherlands. 3. Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 4. The Medical Center Leeuwarden, Department of Pulmonary Diseases, Leeuwarden, The Netherlands. 5. Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 6. Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, AA11, PO Box 30001, 9700 RB, Groningen, The Netherlands. t.s.van.der.werf@umcg.nl. 7. Department of Internal Medicine, Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. t.s.van.der.werf@umcg.nl.
Abstract
BACKGROUND: Patients with pulmonary sarcoidosis commonly present with a dry cough; a productive cough suggests a complicating airway infection or an alternative diagnosis such as tuberculosis or bronchiectasis. CASE PRESENTATION: A 36-year-old European (Frisian) woman recently diagnosed with pulmonary sarcoidosis presented with debilitating exertional dyspnea and cough productive of glazy mucoid sputum. Several different attempts including video-assisted thoracoscopic biopsies failed to reach a second or alternative diagnosis including an infectious, autoimmune or collagen-vascular condition. She responded to steroids but with poor tolerance to this treatment, which could not be tapered. After she was started on anti-tumor necrosis factor alpha (TNF-α) therapy with infliximab, 200 mg at three-monthly intervals, she has been fine for well over a decade. CONCLUSIONS: In this patient with sarcoidosis who had a productive cough accompanied by fever, an extensive workup and prolonged follow-up, an alternative or second diagnosis could be ruled out; we therefore conclude that this highly unusual presentation is part of the clinical spectrum of sarcoidosis.
BACKGROUND:Patients with pulmonary sarcoidosis commonly present with a dry cough; a productive cough suggests a complicating airway infection or an alternative diagnosis such as tuberculosis or bronchiectasis. CASE PRESENTATION: A 36-year-old European (Frisian) woman recently diagnosed with pulmonary sarcoidosis presented with debilitating exertional dyspnea and cough productive of glazy mucoid sputum. Several different attempts including video-assisted thoracoscopic biopsies failed to reach a second or alternative diagnosis including an infectious, autoimmune or collagen-vascular condition. She responded to steroids but with poor tolerance to this treatment, which could not be tapered. After she was started on anti-tumor necrosis factor alpha (TNF-α) therapy with infliximab, 200 mg at three-monthly intervals, she has been fine for well over a decade. CONCLUSIONS: In this patient with sarcoidosis who had a productive cough accompanied by fever, an extensive workup and prolonged follow-up, an alternative or second diagnosis could be ruled out; we therefore conclude that this highly unusual presentation is part of the clinical spectrum of sarcoidosis.
Authors: Branislav S Gvozdenovic; Violeta V Mihailovic-Vucinic; Mira H Vukovic; Mihailo I Stjepanovic; Ivana Buha; Strahinja V Mihailovic; Nikola B Maric Journal: Sarcoidosis Vasc Diffuse Lung Dis Date: 2020-06-30 Impact factor: 0.670