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Pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid: a case report.

Kumagai T, Tomita Y, Inoue T, Uchida J, Nishino K, Imamura F - J Med Case Rep (2015)

Bottom Line: Her serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels were elevated.Histological analysis of a resected subcutaneous nodule, and biopsy specimens from a right mediastinal lymph node and from her right lung revealed non-caseous epithelioid granulomas.Because pleural effusion did not resolve spontaneously and her symptom of dyspnea on exertion worsened, corticosteroid therapy was initiated, which ameliorated the sarcoidosis and the pleuritis.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi Higashinari-ku, Osaka, 537-8511, Japan. torukumagai@ybb.ne.jp.

ABSTRACT

Introduction: Pleural effusion induced by sarcoidosis is rare, and pleural sarcoidosis is often diagnosed by thoracoscopic surgery. The diagnosis of pleural sarcoidosis using thoracentesis may be less invasive when sarcoidosis is already diagnosed histologically in more than one organ specimen. Here we report the case of a 64-year-old woman with pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis. This case report is important because it highlights the usefulness of the CD4/CD8 lymphocyte ratio in pleural effusion as an indicator of pleural involvement of sarcoidosis.

Case presentation: A 64-year-old Japanese woman visited our hospital with an initial symptom of dyspnea on exertion for a period of 4 months. Chest computed tomography showed bilateral hilar and multiple mediastinal lymphadenopathy, multiple small nodular shadows in her bilateral lungs, small nodular shadows along the interlobar pleura, and bilateral pleural effusion. Her serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels were elevated. Histological analysis of a resected subcutaneous nodule, and biopsy specimens from a right mediastinal lymph node and from her right lung revealed non-caseous epithelioid granulomas. Her bronchoalveolar lavage fluid exhibited a predominance of lymphocytes together with an increase in the CD4/CD8 lymphocyte ratio. The lymphocytic predominance and the increased CD4/CD8 lymphocyte ratio were also detected in the right-sided pleural effusion fluid obtained by thoracentesis. We diagnosed sarcoidosis with pleural involvement. Because pleural effusion did not resolve spontaneously and her symptom of dyspnea on exertion worsened, corticosteroid therapy was initiated, which ameliorated the sarcoidosis and the pleuritis.

Conclusions: Analysis of the CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis may be helpful for the diagnosis of pleural sarcoidosis when the diagnosis is already made by histological examination of more than one organ specimen.

No MeSH data available.


Related in: MedlinePlus

Chest radiography. a Before the first admission. b Before the initiation of corticosteroid therapy. c Five weeks after the initiation of corticosteroid therapy
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Fig1: Chest radiography. a Before the first admission. b Before the initiation of corticosteroid therapy. c Five weeks after the initiation of corticosteroid therapy

Mentions: A 64-year-old Japanese woman visited our hospital with an initial symptom of dyspnea on exertion. For the past 4 months she had shortness of breath when she walked approximately 100 meters or went up 10 to 20 steps of a staircase. She visited her neighboring hospital 1 month before visiting our hospital where she received a diagnosis of bilateral pleural effusions and seven sessions of thoracentesis; however, no clinical diagnosis could be made although her dyspnea on exertion was slightly improved by the frequent thoracentesis. When she visited our hospital for the first time, she felt dyspnea on exertion on the ground level after several hundred meters. Before she had dyspnea on exertion, she had not had any diseases including sarcoidosis nor had she received any continuous medications such as immunosuppressive drugs. She had no previous history relating pleural effusion, and no family history of sarcoidosis. She did not have any past history for opportunistic infections. A chest radiograph showed the enlargement of bilateral hilar shadows, reticulonodular shadows in bilateral lung fields, and dullness at the right costophrenic angle (Fig. 1a). Her serum angiotensin-converting enzyme (ACE) level was elevated to 44.2 IU/L. Her immunoglobulin G (IgG) and sIL2R levels were also elevated (Table 1). Bacterial culture for sputum resulted in negative findings for tuberculosis. Polymerase chain reaction (PCR) analysis also showed no tuberculosis in her sputum.Fig. 1


Pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid: a case report.

Kumagai T, Tomita Y, Inoue T, Uchida J, Nishino K, Imamura F - J Med Case Rep (2015)

Chest radiography. a Before the first admission. b Before the initiation of corticosteroid therapy. c Five weeks after the initiation of corticosteroid therapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536796&req=5

Fig1: Chest radiography. a Before the first admission. b Before the initiation of corticosteroid therapy. c Five weeks after the initiation of corticosteroid therapy
Mentions: A 64-year-old Japanese woman visited our hospital with an initial symptom of dyspnea on exertion. For the past 4 months she had shortness of breath when she walked approximately 100 meters or went up 10 to 20 steps of a staircase. She visited her neighboring hospital 1 month before visiting our hospital where she received a diagnosis of bilateral pleural effusions and seven sessions of thoracentesis; however, no clinical diagnosis could be made although her dyspnea on exertion was slightly improved by the frequent thoracentesis. When she visited our hospital for the first time, she felt dyspnea on exertion on the ground level after several hundred meters. Before she had dyspnea on exertion, she had not had any diseases including sarcoidosis nor had she received any continuous medications such as immunosuppressive drugs. She had no previous history relating pleural effusion, and no family history of sarcoidosis. She did not have any past history for opportunistic infections. A chest radiograph showed the enlargement of bilateral hilar shadows, reticulonodular shadows in bilateral lung fields, and dullness at the right costophrenic angle (Fig. 1a). Her serum angiotensin-converting enzyme (ACE) level was elevated to 44.2 IU/L. Her immunoglobulin G (IgG) and sIL2R levels were also elevated (Table 1). Bacterial culture for sputum resulted in negative findings for tuberculosis. Polymerase chain reaction (PCR) analysis also showed no tuberculosis in her sputum.Fig. 1

Bottom Line: Her serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels were elevated.Histological analysis of a resected subcutaneous nodule, and biopsy specimens from a right mediastinal lymph node and from her right lung revealed non-caseous epithelioid granulomas.Because pleural effusion did not resolve spontaneously and her symptom of dyspnea on exertion worsened, corticosteroid therapy was initiated, which ameliorated the sarcoidosis and the pleuritis.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi Higashinari-ku, Osaka, 537-8511, Japan. torukumagai@ybb.ne.jp.

ABSTRACT

Introduction: Pleural effusion induced by sarcoidosis is rare, and pleural sarcoidosis is often diagnosed by thoracoscopic surgery. The diagnosis of pleural sarcoidosis using thoracentesis may be less invasive when sarcoidosis is already diagnosed histologically in more than one organ specimen. Here we report the case of a 64-year-old woman with pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis. This case report is important because it highlights the usefulness of the CD4/CD8 lymphocyte ratio in pleural effusion as an indicator of pleural involvement of sarcoidosis.

Case presentation: A 64-year-old Japanese woman visited our hospital with an initial symptom of dyspnea on exertion for a period of 4 months. Chest computed tomography showed bilateral hilar and multiple mediastinal lymphadenopathy, multiple small nodular shadows in her bilateral lungs, small nodular shadows along the interlobar pleura, and bilateral pleural effusion. Her serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels were elevated. Histological analysis of a resected subcutaneous nodule, and biopsy specimens from a right mediastinal lymph node and from her right lung revealed non-caseous epithelioid granulomas. Her bronchoalveolar lavage fluid exhibited a predominance of lymphocytes together with an increase in the CD4/CD8 lymphocyte ratio. The lymphocytic predominance and the increased CD4/CD8 lymphocyte ratio were also detected in the right-sided pleural effusion fluid obtained by thoracentesis. We diagnosed sarcoidosis with pleural involvement. Because pleural effusion did not resolve spontaneously and her symptom of dyspnea on exertion worsened, corticosteroid therapy was initiated, which ameliorated the sarcoidosis and the pleuritis.

Conclusions: Analysis of the CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis may be helpful for the diagnosis of pleural sarcoidosis when the diagnosis is already made by histological examination of more than one organ specimen.

No MeSH data available.


Related in: MedlinePlus