We report the case of a 61-year-old Causasian man with a history of NYHA grade II dyspnea and unproductive cough lasting several months. He was a former smoker (20 pack-years, with cessation 20 years previously). Lung function tests (Fig. 1A) showed mild obstruction (forced expiratory volume in 1s [FEV1] 2.43l, 74% predicted, Tiffeneau index 61%, residual volume [RV] 2.29l, 94% predicted, total lung capacity [TLC] 6.2l, 89% predicted, RV/TLC 37%) and slightly reduced gas exchange (DLCO 53% predicted, KCO 75% predicted, alveolar volume 4.94l, 71% predicted). Chest X-ray was normal (stage 0) and chest CT (Fig. 1B) showed mainly bronchiectasis in the left lower lobe, with no mediastinal or hilar lymphadenopathies. Miniscule disseminated granulomatous lesions spreading from the upper trachea to the segmentary and sub-segmentary bronchi on both sides with circular distribution in all membranous and cartilaginous parts of the airways were observed on bronchoscopy. Lymphocytosis (45%) with a raised CD4/CD8 ratio (4.5) was observed in bronchoalveolar lavage fluid. Non-caseating epithelioid cell granulomas were identified in bronchial biopsy material (Fig. 1F). Staining and cultures for acid-resistant microorganisms and mycoses were negative.
(A) Lung function tests showing mild obstruction. (B) Chest computed tomography showing mainly bronchiectasis in the left lower lobe. (C)–(E) Bronchoscopy showing miniscule disseminated lesions, spreading from the upper trachea to the segmentary and sub-segmentary bronchi on both sides, with circular distribution in all membranous and cartilaginous parts of the airways. (F) Non-caseating epithelioid cell granulomas.
Extensive endoluminal sarcoidosis with mild parenchymal involvement and no lymph node involvement is very uncommon.1,2 The treatment of disseminated endoluminal disease is challenging and is aimed at preventing fixed obstruction. Inhaled corticosteroids and bronchodilators were initiated, with clinical and endoscopic monitoring of the patient's progress and lung function.
Conflict of InterestsThe authors have no conflict of interests with the contents of this article.
Please cite this article as: Lovis A, Noirez L, Letovanec I, Walker A. Lesiones endobronquiales extensas en un paciente con sarcoidosis en estadio 0. Arch Bronconeumol. 2015;51:367–368.
