Arterial Stenosis From Sarcoidosis-Associated Adenopathy and Fibrosing Mediastinitis Leading to Pulmonary Infarction

Sarcoidosis is a systemic, granulomatous disorder commonly affecting the lungs that has the potential to cause numerous thoracic complications. We present a novel case of a 44-year-old woman with pulmonary sarcoidosis who demonstrated a large pulmonary infarction. The disease presentation ultimately was attributed to arterial stenosis resulting from sarcoidosis-associated fibrosing mediastinitis and compressive mediastinal adenopathy. The patient was treated with an extended course of prednisone and subsequently was transitioned to azathioprine with eventual resolution of symptoms, but persistence of imaging findings. Further treatment strategies were considered, including rituximab and vascular stenting, although not pursued. To our knowledge, this is the first reported case of pulmonary infarction caused by this mechanism, exemplifying the complex ways in which sarcoidosis can manifest.