Sarcoidosis with a Necrotizing Sarcoid Granulomatosis Pattern Presenting as Persistent Low-Grade Fever: A Case Report

Area of Science:

• Pulmonology
• Pathology
• Radiology

Background:

• Necrotizing sarcoid granulomatosis (NSG) is an uncommon variant of sarcoidosis.
• It is characterized by granulomas, vasculitis, and necrosis.
• NSG typically presents as solitary or multiple lung nodules or masses.

Observation:

• This report details a case of NSG presenting with persistent low-grade fever.
• Unlike typical presentations, this case showed diffuse micronodules with perilymphatic and random distribution on CT.
• Histological examination revealed widespread necrotizing granulomas with anthracotic pigmentation, necrosis, and vasculitis.

Findings:

• Diagnosis of NSG was confirmed via multidisciplinary discussion.
• The patient received oral prednisolone for treatment.
• Significant clinical and radiological improvement was observed within three months.

Implications:

• This case expands the understanding of NSG's diverse radiological presentations.
• It underscores the importance of multidisciplinary collaboration in diagnosing rare conditions.
• Early diagnosis and treatment with corticosteroids can lead to favorable outcomes in NSG.