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Sarcoidosis: single bulky mesenteric lymph node mimicking a lymphoma
P Fazzi1, S Solfanelli, G Morelli
12nd Medical Clinic, University of Pisa, Italy.
Sarcoidosis
|March 1, 1995
Summary
A previously healthy man experienced severe abdominal pain due to a mesenteric mass. Sarcoidosis was diagnosed, and steroid therapy led to a full recovery with normalized disease markers.
Area of Science:
- Internal Medicine
- Pulmonology
- Radiology
Background:
- Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
- Abdominal involvement is rare, but can present as masses or lymphadenopathy.
- Early diagnosis and treatment are crucial for managing sarcoidosis.
Observation:
- A previously healthy male presented with acute abdominal pain radiating to the lumbar, iliac fossa, and testicular regions.
- Imaging revealed a bulky mesenteric mass with enlarged mesenteric, paraaortic, and paracaval lymph nodes.
- Pulmonary involvement was indicated by chest CT and gallium scan, with bronchoalveolar lavage showing alveolitis.
Findings:
- Biopsy of the mesenteric mass confirmed non-caseating granulomas, consistent with sarcoidosis.
- Elevated serum angiotensin-converting enzyme (SACE) levels supported the diagnosis.
- The patient showed complete resolution of symptoms and normalization of disease markers after two years of steroid therapy.
Implications:
- This case highlights the importance of considering sarcoidosis in the differential diagnosis of unexplained abdominal masses and pain.
- Aggressive immunosuppressive therapy, such as steroids, can be highly effective in treating abdominal sarcoidosis.
- Long-term monitoring is essential to ensure sustained remission and prevent relapse.