臨床病理学ジャーナル

抽象的な

Sarcoidosis and Idiopathic Pulmonary Fibrosis: A Diagnostic and Therapeutic Challenge

Michael T Olson, Sreeja Biswas Roy, Rajat Walia, Ashwini Arjuna

A 59-year-old woman was referred to our Advanced Lung Disease Center for consideration for lung transplantation for stage IV sarcoidosis. She initially presented three years earlier with worsening dyspnea. Highresolution computed tomography of the chest at that time demonstrated ground-glass opacities, traction bronchiectasis, and a 4.5-cm Ascending Aortic Aneurysm (AAA). Biopsy of the lymph nodes revealed noncaseating granulomas. A diagnosis of sarcoidosis with fibrotic changes was plausible; yet, the disease progressed over time despite corticotherapy. At our referral center, a Usual Interstitial Pneumonia (UIP)-Idiopathic Pulmonary Fibrosis (IPF) pattern was observed in the lung parenchyma. The patient was denied transplant due to an AAA requiring risky and complex aortic surgery. Rapid deterioration and refractoriness to corticotherapy suggest her diagnosis may have been sarcoidosis with UIP-IPF pattern. This case illustrates the importance of early recognition of disease patterns of potential transplant candidates and pursuit of interventions to address comorbid conditions in a timely manner.