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• W3092780596 abstract "SESSION TITLE: Fellows Diffuse Lung Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sarcoidosis is a multisystem disorder with granulomatous inflammation of the involved tissues. Lung, skin and eyes are the most commonly involved organs. Sarcoidosis can manifest in various presentations in the respiratory system. The most common manifestations are parenchymal involvement from nodules to fibrocystic disease with or without thoracic lymphadenopathy. Endobronchial mucosal irregularities termed as cobblestone pattern is commonly seen but diffuse severe endobronchial involvement is not commonly reported. We present an unusual case of severe cobblestoning mimicking as obstructive lung disease. CASE PRESENTATION: A 26-year-old African American male with no medical history presented with symptoms of wheezing, dyspnea on exertion, productive cough with thick yellowish sputum over the course of three months. He works at a local post office and noticed respiratory symptoms while loading/unloading packages on the delivery truck. He also endorsed symptoms of night sweats and fatigue but denied weight loss, fever, chills or loss of appetite. Chest radiograph was significant for hilar and mediastinal lymphadenopathy. The CT scan of chest confirmed bilateral hilar and mediastinal lymphadenopathy along with multiple small perilymphatic pulmonary nodules with upper lobe predominance. An Endobronchial Ultrasound was performed to sample the lymph nodes for definitive diagnosis. On the initial airway surveillance bronchoscopy, diffuse mucosal irregularity with waxy nodules was noted in the all the large and small airways. Severe mucosal edema was noted with consequential airway luminal narrowing. Endobronchial biopsy and tranbronchial needle aspiration (TBNA) of the bulky thoracic lymph nodes (LN) were performed which revealed non-caseating granulomas in all the specimens. These specimens were also sent for fungal and bacterial (including mycobacteria) cultures, which did not report growth of any microorganisms. Diagnosis of sarcoidosis was confirmed and he was started on oral prednisone. DISCUSSION: Severe endobronchial sarcoidosis is an uncommon manifestation and is present in advanced disease. These endobronchial changes are due to mucosal granulomatous inflammation resulting in waxy nodular appearance which is commonly described as cobblestone pattern in the sarcoidosis literature. The diagnostic yield for sarcoidosis increases when transbronchial biopsy is combined with endobronchial biopsy of the affected mucosal region. Airway narrowing can occur due to mucosal inflammation and swelling in severe cases. In such instances, it may mimic symptoms of an obstructive lung disease. CONCLUSIONS: Our patient’s symptoms were suggestive of obstructive lung disease with dyspnea, cough and wheezing but radiographic findings concerning for sarcoidosis which was confirmed by biopsy of LNs and mucosa. This is in accordance with the famous quote by Dr. Chevalier Jackson, “All that wheezes is not asthma.” Reference #1: Shorr, A. F., Torrington, K. G., & Hnatiuk, W. (2001). Endobronchial biopsy for sarcoidosis: a prospective study. Chest, 120(1), 109-114. Reference #2: Hutson, T. E., Coulter, T. D., & Mehta, A. C. (2001). Endobronchial sarcoidosis. Journal of Bronchology & Interventional Pulmonology, 8(3), 211-212. Reference #3: Bjermer, L., Thunell, M., Rosenhall, L., & Stjernberg, N. (1991). Endobronchial biopsy positive sarcoidosis: relation to bronchoalveolar lavage and course of disease. Respiratory medicine, 85(3), 229-234. DISCLOSURES: No relevant relationships by James Finley, source=Web Response No relevant relationships by Ishan Lalani, source=Web Response No relevant relationships by Omid Savari, source=Web Response" @default.
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• W3092780596 title "COBBLESTONE PAVEMENT ALONG THE ENTIRE CITY OF SARCOIDVILLE: DIFFUSE ENDOBRONCHIAL INVOLVEMENT OF ALL THE AIRWAYS IN A SARCOIDOSIS PATIENT" @default.
• W3092780596 doi "https://doi.org/10.1016/j.chest.2020.08.1014" @default.
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