Pulmonary and ovarian sarcoidosis – a diagnosis to consider

Abstract

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Tuberculosis may precede, coexist with sarcoidosis or, less frequently, is an opportunistic disease in patients with sarcoidosis under corticosteroid therapy. The authors present the case of a 60-year-old woman who complained of dry cough, fever and night sweats. Subsequently, pelvic mass appeared, with the hypothesis of ovarian neoplasia and submitted to hysterectomy and bilateral annexectomy. Histological examination revealed circumscribed granulomatous structures, constituted by histiocytes, with no evidence of caseous necrosis. In the cultural examination of ascitic fluid, isolation of Mycobacterium tuberculosis. Chest CT revealed multiple mediastinal adenomegalies and diffuse thickening of the interstitium, with a mixed reticular / nodular pattern. She completed 9 months of anti-tuberculosis therapy. Analytically elevation of angiotensin converting enzyme. A transthoracic pulmonary biopsy was performed, which histology revealed interalveolar septa thickened by fibrosis and epithelioid macrophage infiltration with non-caseous granulomas compatible with the diagnosis of sarcoidosis.