Abstract
Background
Sarcoidosis is a multisystem disease characterized by non-caseating granulomas, typically identified by peribronchovascular and perilymphatic nodules on high-resolution computed tomography (HRCT). Miliary sarcoidosis, an atypical presentation involving diffuse pulmonary infiltrates, is rarely reported, occurring in less than 1% of cases.
Case Presentation
We present a case of a 60-year-old Caucasian woman with unexplained weight loss, breathlessness, and cough. Initial chest CT revealed extensive hilar and mediastinal lymphadenopathy with diffuse pulmonary infiltrates, suggesting disseminated malignancy. However, subsequent PET-CT scans showed intense and widespread FDG avidity throughout the lungs and mediastinal nodes, indicative of miliary sarcoidosis. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) confirmed non-caseating granulomas, leading to a diagnosis of sarcoidosis. The patient was treated with oral corticosteroids, resulting in significant clinical and radiological improvement.
Conclusion
This case underscores the importance of recognizing atypical imaging patterns in sarcoidosis, such as miliary distribution, to avoid misdiagnosis and ensure appropriate management. The combination of advanced imaging techniques and minimally invasive biopsy procedures is crucial for accurate diagnosis and effective treatment.