Extra Pulmonary Sarcoidosis Disguised as Nodular Lung and Testicular Lesions

Abstract

Sai Mannam, Haris Hatic and Mohan Krishnamachary

Introduction: Sarcoidosis can affect multiple systems in the body especially the lungs and the skin. In our case, we highlight an extrapulmonary case of sarcoidosis masquerading as lung & testicular mass in a 30-year-old African-American male. Hospital Course: An African American male without previous medical history presented with coughing and testicular swelling for over 1 month. The patient had adrastic weight loss, exertional dyspnea, and bilateral testicular swelling. Smoked daily one-fourthpack-per-day. On physical exam, patient had clear auscultation of the chest bilaterally and large left testicular mass measuring at least 6 cm. Laboratory tests show relatively unremarkable CBC and CMP. LDH was high at 238. Computed tomography of the chest/abd/pelvis without contrast showed innumerable pulmonary nodules in the bilateral lungs. Ultrasound of testicles found numerous bilateral hypoechoic testicular lesions. A right upper lung endobronchial biopsy revealed granulomatous inflammation without malignant cells related to pulmonary sarcoidosis with testicular involvement. ACE send-out was high at 138 U/L. Patient was started on steroids with 10 mg daily and doxycycline 100 mg twice daily for seven days. Discussion: The “great mimicker” is a well-deserved moniker for sarcoidosis because of its multisystem involvement and broad symptomology it can be a challenging diagnosis. In order to diagnose sarcoidosis, a thorough history and physical exam are required. The genitourinary presentations of sarcoidosis are extremely rare. Extrapulmonary sarcoidosis can regress spontaneously or it can progress in select patients to malignancy which requires tailored treatment with either corticosteroids or orchiectomy.

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