Year: 2025
Type: article
Study design: Case Report
Abstract: Sarcoidosis is a multisystem granulomatous disorder that classically involves the lungs and intrathoracic lymph nodes in a bilateral distribution. Unilateral disease is rare and may closely mimic malignancy, leading to diagnostic uncertainty. We report the case of a 71-year-old man with a history of coronary artery disease, prior tuberculosis exposure, and a 20-pack-year smoking history, who was found to have pleural-based, calcified pulmonary nodules on screening computed tomography (CT) scan. Initial positron emission tomography (PET) imaging demonstrated no avidity; however, follow-up revealed interval growth and new fluorodeoxyglucose (FDG) uptake, prompting CT-guided biopsy. Histopathology showed chronic inflammation with multinucleated giant cell reaction and focal calcification, consistent with sarcoidosis and without evidence of malignancy. The patient later developed cough and wheezing, with symptoms and imaging findings improving on corticosteroid therapy. This case highlights the diagnostic challenges of unilateral sarcoidosis, the limitations of PET in differentiating granulomatous inflammation from malignancy, and the value of surveillance with targeted biopsy. LEARNING POINTS: . In atypical presentations without accessible lymphadenopathy or extrapulmonary disease, percutaneous parenchymal biopsy is essential for diagnosis. Steroid therapy can be highly effective, and a surveillance-first approach can spare patients from invasive procedures.
DOI: 10.12890/2025_005841
Authors: Mit Chauhan, Shubham Patel, Tyagi Ubhadiya, Ibrahim Mahmood, Nader Mahmood
Institutions: St. Mary's Hospital, Saint Michael's Medical Center
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $323
OpenAlex ID: W4415464819