A 66-year-old woman with a history of pulmonary sarcoidosis diagnosed in another hospital in 1993 due to dyspnea and pulmonary radiological compromise suggestive of pulmonary TB, whose study failed to establish the presence of multiple Koch's bacilli and cultures.
A surgical lung biopsy showed noncaseating granulomas.
Ziehl Nielsen staining was negative.
With the diagnosis of pulmonary sarcoidosis, she was treated with 30 mg of prednisone daily for 30 days and then with 10 mg for 2 years.
The sputum smears and Koch cultures performed later were always negative.
She presented with dyspnea and signs of bronchial obstruction in May 1999.
The chest X-ray showed extensive bilateral residual lesions, especially in the right upper lobe and advanced obstructive ventilatory defect revealed a limitation.
In July that year, the patient was hospitalized due to suspicion of dyspnea and pulmonary TBC. A bronchial biopsy was performed, which revealed non-case presentation granulomas and negativity for the tuberculosis study.
The patient remained in regular outpatient follow-up and was maintained on short-acting bronchodilators with clinical and functional stability.
Since 2003, accusation of dyspnea with reduction in activities of daily living and recurrent bronchial infections that have required frequent antibiotic therapy was stressed.
Treatment was switched to long-acting β2 adrenergic bronchodilators associated with inhaled corticosteroids and later to tiotropium with partial relief of dyspnea, which allowed resume activities of daily living.
1.
Being stable of his lung problem, in late 2006, he had frequent episodes of nausea and vomiting.
An endoscopy performed in another care center showed edema, congestion, erosions and ulcerations at the gastric antrum.
The gastric mucosa biopsy showed noncaseating granulomas compatible with sarcoidosis.
Semi-liquid feeding was indicated plus 20 mg every 12 h with partial reduction of symptoms.
Due to persistent gastric discomfort, 30 mg prednisone daily was added, an important relief of dyspepsia after 4 months of treatment decreased the dose to 20 mg daily.
Control endoscopy showed thickening of the mucosa of the fundus and gastric body with the presence of nodules at the level of the gastric antrum, whose biopsy showed chronic superficial gastritis and epithelioid granulomas, some with asteric bodies.
Duodenal biopsy showed no abnormalities.
CT enterography ruled out intestinal involvement.
1.
In control in August 2008, the patient reported less dysphagia, without nausea or vomiting and had regained 4 kg of weight, so prednisone was reduced to 10 mg daily.
Currently, dyspnea on exertion persists, and oxygen administration has been required, especially during physical activities due to exercise hypoxemia.
Figure 1b corresponds to a current X-ray showing increased retraction of the right upper lobe.
The evolution of pulmonary function is summarized in Tables 1 and 2, which demonstrate a progressive commitment, with only an improvement in the VFC in the penultimate control.
In addition, a severe impairment of functional capacity is observed, with a reduction from 308 to 188 meters in the 6MWT, together with hypoxemia at the end of the test.
1.
The current blood count and biochemical profile are normal.
Sarcoidosis is not a pathological finding.
