[A case of sarcoidosis with middle lobe atelectasis]

We report a case of sarcoidosis complicated by middle lobe atelectasis. A chest radiograph and a chest CT film on admission revealed middle lobe atelectasis and mediastinal lymphadenopathy. Bronchofiberscopic findings showed slit-like stenosis and reddish, edematous mucosal change of the middle lobe orifice. On admission, the serum angiotensin-converting enzyme (ACE) level was within the normal range. However, the ACE level had increased beyond the normal range by 2 months later, histological examination of a specimen from a transbronchial lung biopsy (TBLB) of the middle lobe revealed noncaseating epithelioid cell granulomas. We diagnosed sarcoidosis because of the histological findings from the TBLB and serum ACE elevation. Treatment with predonisolone resulted in remarkable alleviation of middle lobe atelectasis and mediastinal lymphadenopathy. Cases of sarcoidosis with middle lobe atelectasis are rare in Japan.