Sneaky Sarcoidosis or a Metastatic Masquerade? - A case of nodular sarcoidosis

Sarcoidosis is a multisystem disease of unclear pathogenesis that peaks between ages 20 to 39. Sarcoidosis is more common in women and affects blacks three times more frequently than whites. Nodular sarcoidosis is a rare variant of sarcoid that occurs in 1-4 percent of patients. It presents in female smokers with cough and shortness of breath. Nodular sarcoidosis often also presents as multifocal bilateral ill-defined nodules mimicking airspace disease or malignancy on imaging. Patients generally have a favorable prognosis, with complete resolution of the masses with steroid treatment. Herein, we present a case of nodular sarcoidosis in a female smoker who presented with cough, weight loss, and fever. Imaging revealed multiple pulmonary nodules, a dominant lung mass, and lymphadenopathy suggestive of malignancy. Ultimately, the patient underwent bronchoscopy and was diagnosed with nodular sarcoidosis; there was no evidence of malignancy or infectious process. Resolution of her symptoms ensued with steroid treatment.