Thursday, July 26, 2007

Steroid responsive adenopathy?

65-year-old woman presented initially for evaluation of shortness of breath. A CT thorax revealed some patchy airspace opacification RUL (see below) . She underwent bronchoscopic evaluation and it demonstrated some interstitial inflammation with hyperplastic type 2 pneumoctyes. No granulomas seen. No fungal or AFB elements on BAL. A cell count was not sent.
She was begun on a course of steroids 40mg and felt her breathing improved significantly while on them, but once she stopped them, her shortness of breath recurred. Her cough has also recurred, though it's mostly non-productive. A CT was repeated 5 monts later and is shown below.

Question: What ILD had adenopathy and is steroid responsive? The only 2 I can think of are sarcoid and berrylliosis, but the interstial inflammation would be inconsistent with that. Any thoughts out there?

3 comments - CLICK HERE to read & add your own!:

Lima Doc said...

Why would sarcoid be ruled out? What about HP? or atypical presentation of CEP?

Jennings said...

becuase it's atypical to have *interstitial* inflammation with sarcoid.

Anonymous said...

I think this is perfectly compatible with sarcoidosis.