Pleural Effusion in Sarcoidosis: Unveiling a Rare Complication in a Clinical Case
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-9-2025
Abstract
Sarcoidosis is chronic granulomatous disease affecting multiple organ systems with variable progression and prognosis in each patient. Constellations of symptoms vary from cough, dyspnea, uveitis, and erythema nodosum. In approximately 1% of sarcoidosis patients develop a sarcoidosis associated pleural effusion (SAPE). These pleural effusions are characterized by unilateral lymphocytic exudative effusions and occur within the first year of diagnosis. Although a pleural biopsy is required for diagnosis of SAPE, the diagnosis may be established based on the clinical features alone in the setting of no other contributing conditions.
A 76-year-old female with a history of pulmonary and cutaneous sarcoidosis presented with progressively worsening dyspnea. Initial pulmonary function tests (PFTs) showed declining lung function despite optimized inhaled corticosteroid therapy. Chest X-ray revealed a moderate right-sided pleural effusion. Thoracentesis was performed, yielding a lymphocytic pleural exudate with negative cytology and cultures.
Two weeks later, a follow-up chest CT scan showed recurrent right-sided pleural effusion, bilateral hilar lymph node calcifications, and small pulmonary nodules. Pleuroscopy was performed, and pleural biopsies revealed non-caseating granulomas. Negative acid-fast bacillus (AFB) and fungal cultures excluded infectious causes, leading to the diagnosis of SAPE. The patient was initiated on a prednisone taper, which resulted in symptomatic improvement. A tunneled pleural catheter was placed during pleuroscopy to alleviate dyspnea and facilitate pleurodesis. Plans were made for further consultation with interventional pulmonology to obtain additional biopsies to rule out malignancy.
SAPE is a rare but significant manifestation of sarcoidosis that requires prompt diagnosis and management. In this case, the use of pleuroscopy with pleural biopsies confirmed the diagnosis and facilitated symptom management through the placement of a tunneled pleural catheter. MT offers a safe and effective alternative to more invasive procedures, providing an important tool for diagnosing and managing pleural effusions in sarcoidosis patients. This case underscores the importance of considering SAPE in patients with known sarcoidosis who present with pleural effusion.
Recommended Citation
Alsaedi H, Akbar S, Egan J. Pleural effusion in sarcoidosis: unveiling a rare complication in a clinical case. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1842