Pulmonary Sarcoidosis Presenting with Miliary Opacities

Area of Science:

• Pulmonary Medicine
• Rare Diseases
• Diagnostic Challenges

Background:

• Sarcoidosis commonly presents with lung lesions, but miliary opacities are an infrequent manifestation.
• A 55-year-old Indian male presented with dyspnea and low-grade fever, prompting an initial investigation for infectious causes.

Observation:

• Miliary opacities on imaging and caseating granulomas on transbronchial biopsy initially suggested Miliary Tuberculosis (TB).
• Direct microscopic examination for acid-fast bacilli was negative, and the patient showed no improvement with standard anti-tubercular therapy.
• Negative Mycobacterium cultures and subsequent clinical and histopathological re-evaluation led to a revised diagnosis of sarcoidosis.

Findings:

• Miliary sarcoidosis is a rare cause of diffuse lung opacities.
• Distinguishing miliary sarcoidosis from Miliary Tuberculosis can be challenging due to overlapping clinical and pathological features.

Implications:

• Physicians should include sarcoidosis in the differential diagnosis for miliary opacities, especially when tuberculosis and other conditions are ruled out or treatment fails.
• This case underscores the need for comprehensive evaluation and re-evaluation in complex pulmonary cases presenting with rare radiological patterns.