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Sarcoidosis in the context of fever of unknown origin – a case report

Dimo Nikolov, Veselin Alexandrov, Rady Lukanov, Simona Panteleymonova, Vanya Kostadinova

Abstract

Introduction: Sarcoidosis is a multisystem inflammatory disease that manifests with distinctive his­tological characteristics - noncaseating granulomas, predominantly in the lungs and intrathoracic lymph nodes. An exaggerated immune response against a difficult–to-discern antigen characterize the disease. Sarcoidosis is known to have a wide age range, usually between 20-40 years and to affect both males and females.

Material and methods: We report a case of a 53-year old man, admitted to the hospital with persisting fever after 7-days of treatment with Levofloxacin. He had no other findings on his physical examina­tion. The conducted radiography (X-ray) and computed tomography scan (CT-scan) found mediasti­nal lymphadenomegaly combined with a suspect tumour formation in the right lung. The discoveries required performing an additional transbronchial biopsy to discern the possible conditions. The dif­ferential diagnosis included pulmonary carcinoma, lymphoma, toxoplasmosis and sarcoidosis.

Results: The performed biopsy found noncaseating epithelioid granulomas without any signs of toxo­plasmas’ pseudocysts. When the classic clinical and radiologic findings are supported by histological evidence of specific granulomata then the diagnosis of sarcoidosis can be confirmed. At the time of the examinations, the patient was in roentgenologic stage 2. The indicated treatment with corticoste­roids, which are the mainstay of the therapy of sarcoidosis improved the patient’s condition and re­duced the fever he had. He remained under constant observation.

Conclusions: The case presents an occurrence of sarcoidosis with a persisting fever as its isolated manifestation. It illustrates the difficulties of differentiating the disease, which presentation varies with the extent and severity of organ involvement – from asymptomatic to a highly symptomatic one.


Keywords

sarcoidosis; fever of unknown origin; differential diagnosis




DOI: http://dx.doi.org/10.14748/ssvs.v2i0.4648

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