[An unusual presentation of sarcoidosis]

A 52-year-old man was admitted to our hospital with chief complaints of fever, general fatigue, and weight loss. A chest roentgenogram showed hyperinflation and many small nodular shadows in both lung fields. A chest CT scan showed centrilobular shadows distributed equally over all lung fields. Examination of a transbronchial lung biopsy specimen revealed a small non-caseating granuloma composed of a giant cell of Langhans type, epithelioid cells, and a few lymphocytes. There was a dark red eruption about 1 cm in diameter on the right forearm, which had been present for a few years, to the best of the patient's memory. Examination of a skin biopsy specimen revealed many non-caseating granulomas composed of epithelioid cells. Uveitis developed about 2 months after admission. Our diagnosis was sarcoidosis. Steroid therapy was started. The patient's symptoms rapidly disappeared and a chest roentgenogram showed remarkable improvement. We believe this was a very peculiar case of sarcoidosis: the patient had systemic symptoms only, and roentgenographic examinations showed hyperinflation and centrilobular shadows distributed over all lung fields.