Include Pulmonary Sarcoidosis in Chest Pain Diagnosis, Case Report Advises

A case study diagnosing pulmonary sarcoidosis in a patient complaining of chest pain and shortness of breath highlights the importance of including sarcoidosis in the differential diagnosis of chest pain.

The study, “Sarcoidosis Presenting as Acute Respiratory Distress Syndrome,” was published in the journal Clinical Practice and Cases in Emergency Medicine.

Sarcoidosis is an inflammatory disease of unknown cause that can affect several organs in the body, especially the lungs, a condition known as pulmonary sarcoidosis. Patients with pulmonary sarcoidosis can experience persistent dry cough, shortness of breath, fatigue or chest pain.

Chest pain is one of the most common complaints seen by emergency care providers. Emergency clinicians must be able to differentiate the different causes of chest pain to minimize both acute and long-term morbidity and mortality.

Researchers at Kingman Regional Medical Center, Arizona, reported the case of a patient with chest pain who was diagnosed with pulmonary sarcoidosis.

The patient, a 36-year-old white man, was admitted to the hospital after experiencing four months of left-sided chest pain and shortness of breath.

The man complained of a chronic dry cough he had for several years, which was not associated with disease or exercise. He denied ever smoking or having family history of autoimmune or genetic diseases.

Upon arrival at the hospital, the man’s physical examination and laboratory values were within normal limits. These included vital signs, lung sounds (egophony), cardiac rhythm (electrocardiogram) and blood testing.

Lung imaging tests, including chest radiography and computed tomography, showed nodules on both sides of the lungs, but appeared to be worse on the left side.

Discussing with the pulmonology department, the medical team considered lymphoma, tuberculosis, fungal infections, and pulmonary sarcoidosis as possible diagnoses.

Bronchoalveolar lavage — a procedure in which a fluid is squirted into a small portion of the lung and then aspirated to be analyzed — was negative for both fungal and bacterial infections, as well as for malignant cells.

Lung biopsies, in which a small piece of lung tissue is removed to be examined, revealed clumps of inflamed immune cells known as granulomas.

The man was diagnosed with stage 3 pulmonary sarcoidosis, which is characterized by granulomas present in the lungs only.

The man started treatment with prednisone daily and sulfamethoxazole/trimethoprim combination therapy three times a week for eight weeks. All symptoms resolved after treatment.

“Although emergency clinicians are trained in diagnosing and treating the deadly causes of chest pain, they must take one step further when diagnosing a patient with a relatively low-risk disease,” the researchers wrote.

“Although not normally a cause of short-term morbidity or mortality, pulmonary sarcoidosis should be considered as an acute cause of chest pain in the correct patient population and should be managed aggressively to prevent long-term complications from the disease,” the team added.