Sarcoidosis With Pleural Effusion as the Presenting Symptom

Area of Science:

• Pulmonology
• Cardiology
• Oncology

Background:

• Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomas.
• Pleural effusions are uncommon manifestations of sarcoidosis, typically presenting as exudative effusions.
• This case involves a patient with a history of hypertension, nonischemic cardiomyopathy, and pulmonary hypertension.

Observation:

• A 65-year-old woman presented with symptomatic bilateral pleural effusions.
• Thoracentesis revealed a lymphocyte-predominant transudate, with negative results for malignancy and infection.
• Imaging showed mediastinal and hilar lymphadenopathy, leading to a biopsy confirming non-necrotizing granulomas.

Findings:

• Biopsy-confirmed sarcoidosis was the etiology of the persistent pleural effusions.
• Cardiac evaluation for sarcoid involvement was negative.
• The pleural effusion was characterized as a transudate, which is atypical for sarcoidosis.

Implications:

• This case represents the first documented instance of sarcoidosis manifesting as a large transudative pleural effusion.
• It underscores the importance of considering sarcoidosis in the differential diagnosis of unexplained transudative pleural effusions, even in the absence of typical systemic symptoms.
• Further research may be warranted to explore the mechanisms behind sarcoidosis-induced transudative effusions.