Bronchial purging: Atypical pulmonary sarcoidosis presenting
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Published in the journal Lung India, the authors present a case of a 45-year-old male, a smoker who came with complaints of cough and breathlessness with bronchorrhea (>100 ml/day) for 1 year and weight loss for the last 4 months.

He was on empirical antituberculosis treatment (4 drugs-RHZE) for 1 month from outside with no relief. Sputum cytology was negative for any malignancy, acid fast bacilli smear and gene expert were also negative. Keeping in view of malignancy as the most common cause of bronchorrhea, PET-CT imaging was done which revealed metabolically active soft-tissue dense fibrous lesion with peribronchovascular thickening in bilateral upper lobes and in the right middle lobe along with metabolically active multiple mediastinal lymph nodes.

Endobronchial cryobiopsy, transbronchial lung biopsy and endobronchial ultrasound from lymph nodes stations right paratracheal (4R) and subcarinal (7) were done and showed compact, discrete, multiple, noncaseating granulomas in all tissues sampled (lung, lymph node, and endobronchial mucosa).

Further investigations revealed serum angiotensin-converting enzyme of 107 U/L (normal value 8–52 U/L). The case was further discussed in multi disciplinary meeting (MDD) with radiologist and pathologist in view of atypical clinical. typical radiological and pathological findings.

Judson et al. have stratified confidence level for the diagnosis of sarcoidosis – highly probable, probable, possible, and unlikely based on clinicoradiological and pathological description.

Alternative diagnosis of infections and malignancy were ruled out, and diagnosis of sarcoidosis was made with highly probabale level of confidence and the patient was started on steroids (Tablet deflazacort 6 mg twice daily), on which he showed marked improvement.

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