Ribeiro Elisabete, Marques Leite Letícia, Bessa Isabel, Pacheco João, Gonçalves Filipa
Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT.
Pathology, Hospital Senhora da Oliveira, Guimarães, PRT.
Cureus. 2025 Jan 24;17(1):e77913. doi: 10.7759/cureus.77913. eCollection 2025 Jan.
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Despite primarily affecting the lung, sarcoidosis can affect any organ, resulting in various clinical manifestations. We present a case of a 56-year-old man who developed thoracic pain over several months along with skin lesions. The chest CT revealed multiple mediastinal lymphadenopathies. The patient underwent an endobronchial ultrasound, and a lymph node biopsy was performed. The histological results showed lymphoid cells and small epithelioid granulomas, while bronchoalveolar lavage revealed lymphocytosis, with a significantly elevated CD4+/CD8+ ratio. Based on the results, a diagnosis of sarcoidosis was presumed. The study was concluded with cardiac MRI due to complaints of chest pain, which also confirmed cardiac involvement. The patient was successfully treated with corticosteroids, exhibiting significant improvements and recovering completely during the follow-up period. Despite cardiac involvement in sarcoidosis being rare, we present this case to emphasize the challenges in diagnosis, requiring high clinical suspicion and the use of complementary imaging methods, such as cardiac magnetic resonance. We also emphasize the importance of early initiation of corticosteroid therapy to prevent major complications and promote recovery.
结节病是一种病因不明的多系统肉芽肿性疾病。尽管主要影响肺部，但结节病可累及任何器官，导致各种临床表现。我们报告一例56岁男性，他在数月内出现胸痛并伴有皮肤病变。胸部CT显示多个纵隔淋巴结肿大。患者接受了支气管内超声检查，并进行了淋巴结活检。组织学结果显示淋巴细胞和小上皮样肉芽肿，而支气管肺泡灌洗显示淋巴细胞增多，CD4+/CD8+比值显著升高。根据这些结果，推测为结节病。由于胸痛症状，患者接受了心脏MRI检查，结果也证实了心脏受累。患者接受皮质类固醇治疗成功，症状显著改善，并在随访期间完全康复。尽管结节病累及心脏罕见，但我们报告此病例以强调诊断中的挑战，这需要高度的临床怀疑并使用心脏磁共振等辅助成像方法。我们还强调早期开始皮质类固醇治疗以预防主要并发症并促进康复的重要性。
