Open Access Highly Accessed Case Report

Necrotizing sarcoid granulomatosis with hemoptysis: a case report and literature review

Haidong Huang1, Chen Li2, Chong Bai1, Qiang Li1, Weiqiang Zheng3, Zhi Zhu3, Paul Zarogoulidis45*, Konstantinos Zarogoulidis4, Andreas Gschwendtner6, Wolfgang Hohenforst-Schmidt7 and Michael Simoff8

Author Affiliations

1 Department of Respiratory Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China

2 Department of respiration, First Automobile Works General Hospital/ fourth Affiliated Hospital of Jilin University, Shanghai, China

3 Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai, China

4 Pulmonary Department, G. Papanikolaou`` General Hopspital, Aristotle University of Thessaloniki, Thessaloniki, Greece

5 Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany

6 Pathology Department, Hospital of Amberg, Amberg, Germany

7 II Medical Clinic, ``Coburg`` Hospital, University of Wuerzburg, Coburg, Germany

8 Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA

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Diagnostic Pathology 2013, 8:79  doi:10.1186/1746-1596-8-79

Published: 13 May 2013

Abstract

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We present a case of 39-year-old male with the symptoms of fever, cough, chest pain and bloody phlegm, whose chest CT showed multiple subpleural nodules and inflammatory infiltration. Video-Assisted Thoracic Surgery ( VATS ) for right subplural nodule was performed and confirmed the diagnosis of necrotizing sarcoid granulomatosis. Prednisolone was administered and the symptoms were under control untill the occurrence of intermittent hemoptysis after 10 months. Chest CT and bronchoscope revealed the right lower lobe nodule with intraluminal necrotic tissue in the right lower lobe posterior basal segment respectively. Fatal hemoptysis happened during endobronchial biopsy by flexible bronchoscope forcep. Based on this case, we reviewed the relevant literature and discussed the clinical features, pathological changes and prognosis of the disease.

Keywords:
Necrotizing sarcoid granulomatosis; Granuloma; Vasculitis; Necrosis; Bronchoscopy; Hemoptysis