Breaking symmetry: unilateral sarcoidosis presenting as a diagnostic challenge

Authors

• Mit Chauhan Department of Pulmonary Medicine, Saint Michael’s Medical Center, Newark, USA; Department of Pulmonary Medicine, Saint Mary’s General Hospital, Passaic, USA
• Shubham Patel North Jersey Pulmonary Associates, Ridgewood, USA
• Tyagi Ubhadiya North Jersey Pulmonary Associates, Ridgewood, USA
• Ibrahim Mahmood North Jersey Pulmonary Associates, Ridgewood, USA
• Nader Mahmood Department of Pulmonary Medicine, Saint Michael’s Medical Center, Newark, USA; Department of Pulmonary Medicine, Saint Mary’s General Hospital, Passaic, USA; North Jersey Pulmonary Associates, Ridgewood, USA

mit.chauhan.md@gmail.com

Keywords

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.

References