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• W2765150973 abstract "SESSION TITLE: Sarcoidosis and Cystic Lung Disease SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Sarcoidiosis is a common systemic inflammatory disease that can affect all organ systems; however it primarily affects the lungs. 1 Cardiac involvement typically presents as conduction abnormalities, while pericardial disease is rare. CASE PRESENTATION: A 58 year old woman with a 5 year history of non productive cough presented with acute episode of substernal chest and throat pain that started about two days prior. Her vital signs were stable, but she was found on EKG to have a 1st degree heart block. Her echocardiogram revealed a moderate sized pericardial effusion without tamponade physiology. Her review of system was negative for arthropathy, rash, and her laboratory evaluation was unremarkable with the exception of a leucopenia with a white blood cell count of 3400 cells.mm3. Her rheumatologic evaluation included an ANA, anti-ds DNA, Rheumatoid Factor, ANCA, anti-SSA/SSB antibodies all of which were negative. Of note, she had a similar episode 5 years prior for which she had a pericardiocentesis which was negative for malignant cells. A chest x-ray and CT scan showed bilateral upper lobe predominant nodular infiltrates with a pathologically enlarged 3 cm sub-carinal lymph node (Figure 1). She underwent a bronchoscopy which revealed endobronchial nodularity with cobble-stoning which was biopsied (Figure 2). A bronchoalveolar lavage was also performed which was negative for infection. An EBUS-TBNA of the subcarinal lymph node was notable for non-cesating granulomas with negative cultures and stains for infectious agents consistent with a diagnosis of Sarcoidosis. A cardiac MRI was performed and was negative for myocardial enchancement although it did demonstrate free flowing pericardial effusion. DISCUSSION: Radiographic abnormalities are an established presentation of sarcoidosis, however pericardial effusions are rare and limited to case reports in the literature. The first confirmed case in the United States was that of a young woman who had recurrent effusions and was noted on pericardial biopsy to have non-cesating granulomas. 2 The constellation of nodular pulmonary infiltrates, cardiac conduction abnormalities, mediastinal lymphadenopathy, and non-cesating granulomas in the setting of negative infectious evaluation is consistent with a diagnosis of sarcoidosis. 3 It is noteworthy that the pericardial effusion in this case preceded the pulmonary manifestation by about a half a decade. CONCLUSIONS: Sarcoidosis should be on the differential diagnosis in patients presenting with recurrent pericardial effusion without an alternative cause. Reference #1: Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007 Nov 22;357(21):2153-65. Review. Reference #2: Shiff AD, Blatt CJ, Colp C. Recurrent pericardial effusion secondary to sarcoidosis of the pericardium. N Engl J Med. 1969 Jul 17;281(3):141-3 Reference #3: Bergot E, Paparel P, Zalcman G. Sarcoidosis. N Engl J Med. 2008 Mar 27;358(13):1404 DISCLOSURE: The following authors have nothing to disclose: Shah Ravi, Sunkaru Touray, Anthony Ogunsua, Ryan Shipe, Scott Kopec No Product/Research Disclosure Information" @default.
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• W2765150973 date "2017-10-01" @default.
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• W2765150973 title "Sarcoidosis Presenting as Recurrent Pericardial Effusion: An Unusual Presentation of a Common Disease" @default.
• W2765150973 doi "https://doi.org/10.1016/j.chest.2017.08.506" @default.
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