Leucocytosis in a case of sarcoidosis with pleural involvement--an unknown association

A case of biopsy-proven sarcoidosis with pleural and lung parenchymal involvement is reported. The resolution of neutrophilia and other disease manifestations with azathioprine points towards sarcoidosis being the probable cause. GG, 45 years old male, presented with fever and right-sided chest pain with biochemical features of granulomatous hepatitis and apparently unexplained leucocytosis. Azathioprine 100 mg daily was started; he improved dramatically within 3 weeks with disappearance of pain and normalization of alkaline phosphatase and leucocytosis. All clinical, biochemical and hematological parameters improved subsequently. There were no significant side effects and the patient is doing well after more than three years on azathioprine. The resolution of neutrophilia on treatment of sarcoidosis suggests a causal relationship. However, further follow-up is essential to screen for future hematological abnormalities.