Stoelting Austen, Esperti Shawn, Balanchivadze Nino, Piacentino Valentino, Mangano Andrew
Department of Internal Medicine, Grand Strand Medical Center, 809 82nd Pkwy, Myrtle Beach, SC, 29572, USA.
Department of General Surgery, Grand Strand Medical Center, 809 82nd Pkwy, Myrtle Beach, SC, 29572, USA.
Ann Med Surg (Lond). 2020 Apr 8;54:6-9. doi: 10.1016/j.amsu.2020.03.007. eCollection 2020 Jun.
Sarcoidosis is a multisystem disorder of unknown etiology. Extrapulmonary sarcoidosis can involve any organ, but isolated spleen involvement is rare. Diagnosis can be challenging as other etiologies may have similar presentations. A 58-year-old African American female presented with life threatening epistaxis, anemia, refractory thrombocytopenia, and massive splenomegaly. Lymphoproliferative, infectious, and autoimmune etiologies were eliminated with laboratory testing and bone marrow biopsy. The patient had multiple splenic artery aneurysms precluding an open diagnostic splenectomy. Partial splenic artery embolization was performed, which normalized the platelet count and resolved the spontaneous bleeding. This allowed diagnostic splenectomy and splenic artery repair to be safely performed. Surgical pathology demonstrated extensive non-caseating granulomas consistent with sarcoidosis. We present this case to demonstrate the omnipotent nature of sarcoidosis and a complex multi-disciplinary approach for successful diagnosis and treatment.
结节病是一种病因不明的多系统疾病。肺外结节病可累及任何器官，但孤立性脾脏受累罕见。由于其他病因可能有相似表现，诊断可能具有挑战性。一名58岁非裔美国女性出现危及生命的鼻出血、贫血、难治性血小板减少症和巨大脾肿大。通过实验室检查和骨髓活检排除了淋巴增殖性、感染性和自身免疫性病因。患者有多个脾动脉瘤，排除了开放性诊断性脾切除术。进行了部分脾动脉栓塞术，使血小板计数恢复正常并解决了自发性出血问题。这使得诊断性脾切除术和脾动脉修复得以安全进行。手术病理显示广泛的非干酪样肉芽肿，符合结节病表现。我们展示此病例以证明结节病的多面性以及成功诊断和治疗所需的复杂多学科方法。
