Sarcoidosis: A Case Report of an Often-Misdiagnosed Clinical Entity from Bangladesh

Abstract

Ashmita Yadav, Ram Bahadur Nepali, A M Jahangir Alam, Akhilesh Adhikari, Sujata Yadav, Diwa Shree Maharjan and Aman Yadav

A chronic granulomatous disease of unknown etiology without any definite diagnostic criteria with an incidence of 1-1,00,000 among Asians affects multiple systems of our body and is often misdiagnosed owing to its elusive nature and resemblance with other granulomatous disease , especially tuberculosis (TB) in our subcontinent .A 38 years old diabetic woman came with the complaints of low grade fever, night sweats, cough, weight loss, migratory joint pain involving multiple small joints of hands without any morning stiffness and painful skin lesions which resolved spontaneously. Investigation showed Hb 11.5 g/dl with normocytic normochromic anaemia, increased sedimentation, increased CRP, insignificant MT, RA and ANA serology, Sputum for AFB didn't reveal any Mycobacteria. CXR revealed Bilateral Hilar Lymphadenopathy (BHL) and HRCT lungs showed bilateral hilar, mediastinal lymphadenopathy and pulmonary inflammatory lesions. Angiotensin Converting Enzyme (ACE)was 163 U/L which was higher than the normal. She was diagnosed as a case of sarcoidosis and was treated in line with oral prednisolone 40mg/day which was gradually tapered over a period of 5 months. Methotrexate 15mg/day once a week was supplemented with folic acid every consecutive day.Vaccination against H.influenzae and S.pneumoniae were advised and on subsequent follow ups she has been improving .The mortality rate is around 5% however, early suspicion, diagnosis and treatment can be life saving for the patient.

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