Tuberc Respir Dis.  2009 Dec;67(6):560-564.

A Case of Sarcoidosis with Pancytopenia as Resulting from Bone Marrow Involvement

• Park TS
• Kim DY
• Park SJ
• Kim YR
• Na SY
• Park JW
• Oh DW
• Choi JS
• Jo JM
• Chang Y
• Kim WY
• Choi CM

Abstract

Sarcoidosis is a granulomatous disease that can involve any organ, although it primarily involves the lungs, intrathoracic lymph nodes, skin, and eyes. We present a case of sarcoidosis with pancytopenia, resulting from bone marrow involvement. A 35-year-old man was admitted to hospital for chronic cough and blurred vision. On chest computed tomography, there were multiple pulmonary nodules and mediastinal lymph nodes enlargement. As the patient also showed pancytopenia, we performed a bone marrow biopsy, as well as a transbronchial lung biopsy. Both biopsies showed non-caseating granulomas. We diagnosed the patient with sarcoidosis with pulmonary, bone marrow, uvea, liver and spleen involvement. After oral steroid therapy, the patient's symptoms as well as his pancytopenia improved. We present this case to demonstrate the significance of bone marrow biopsy in cases of sarcoidosis with pancytopenia, as well the possibility of clinical improvement with steroid treatment.

Keyword

Sarcoidosis; Pancytopenia; Bone Marrow

MeSH Terms

Adult
Biopsy
Bone Marrow
Cough
Eye
Granuloma
Humans
Liver
Lung
Lymph Nodes
Multiple Pulmonary Nodules
Pancytopenia
Sarcoidosis
Skin
Spleen
Thorax
Uvea
Vision, Ocular

Figure

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  Figure 1 Chest radiography showed no abnormality.

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  Figure 2 (A) Before steroid treatment, multiple nodules were seen in the pulmonary parenchyma, and (B) mediastinal lymph nodes were noted to be enlarged. (C) The size of the liver and spleen were also increased. (D) After steroid treatment, the size and number of nodules in both lungs had decreased. (E) Enlarged lymph nodes in the mediastinum were also decreased in size and number, and (F) the hepatosplenomegaly had improved.

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  Figure 3 Transbronchial lung biopsy of the right lower lobe showed multiple lesions of granulomatous inflammation with some multinucleated giant cells (H&E stain, ×100).

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  Figure 4 Bone marrow biopsy revealed multifocal granulomatous lesions on (A) the biopsy and (B) the clot sections (A, H&E stain, ×100; B, ×400).

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