Case Report: Sarcoidosis

Sarcoidosis is a chronic granulomatous disease with multisystem involvement and can present with vague symptoms, so the degree of suspicion should be high. Sarcoidosis has a wide range of clinical symptoms, owing to its multisystem involvement. The lungs, peripheral lymphatics, skin, liver, eye, spleen, bone, salivary glands, joints, and heart are the most commonly involved organ systems pathologically. Sarcoidosis often manifests in the fourth decade of life, but it might occasionally manifest in later years. We present a case of 69-year-old woman who initially complained of generalized weakness, fatigue, and joint pain which later progressed to pulmonary and cutaneous symptoms including cough, dyspnea, chest discomfort, and skin nodules. Examination revealed right cervical lymphadenopathy, bilateral basal crackles in lungs, non-tender nodules over the dorsum of bilateral forearm and hand along with erythema nodosum on bilateral legs. Chest radiograph and computed tomography scans were typical of sarcoidosis. Biopsy of the lymph node revealed noncaseating granuloma and serum angiotensinogen converting enzyme level was raised. Treatment was started with 40 mg prednisolone daily and tapered over a year. The patient had clinical and radiological improvement over the duration of therapy and was on regular follow-up with routine investigations. Clinically, the patient is doing well at follow-up. A high degree of suspicion, familiarity with imaging features, and prompt treatment in selected cases may help in diagnosing, evaluating the extent of disease, and guiding optimal health care.