[Sarcoidosis with pulmonary cavitation and calcification]

A 38-year-old man was seen at another hospital because of bilateral reticulo-nodular shadows on a chest X-ray film at the time of a regular health check-up. Pulmonary tuberculosis was diagnosed, and the patient was treated with antituberculous chemotherapy. The shadow did not improve, and the patient was transferred to our hospital. Bacteriological studies for pyogenic bacteria, mycobacteria, and fungi were all negative. Serum levels of angiotensin-converting enzyme and lysozyme were abnormally high. Examination of a specimen obtained by transbronchial lung biopsy revealed noncaseating epithelioid-cell granuloma associated with severe hyalinization. Sarcoidosis was diagnosed. Chest CT showed multiple nodular opacities, some of which were calcified. Oral steroids were given because the lesion was progressing rapidly. Cavitary lesions appeared during tapering of steroid therapy. Bacteriological and fungal studies were negative and transbronchial lung biopsy showed noncaseating epithelioid-cell granuloma. Therefore, the cavitation within the granuloma with hyalinization may have developed because of steroid therapy, and the calcification may have been caused by postorganizing dystrophy.