Long-term Findings in Bullous Sarcoidosis: A Case Report and Literature Review

• Published in: Internal Medicine Vol. 62; no. 16; pp. 2395 - 2400
• Main Authors: Higuchi, Hiroyuki, Okuzumi, Shinichi, Kakimoto, Tomoo, Hamabe, Kenta, Morinaga, Shojiroh, Minematsu, Naoto
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15-08-2023; Japan Science and Technology Agency
• Subjects: Alveoli; Aspergillus; autopsy; bullae; Case Report; Computed tomography; corticosteroid; Internal medicine; Literature reviews; nontuberculous Mycobacterium; Sarcoidosis; corticosteroid; nontuberculous Mycobacterium; Aspergillus; bullae; sarcoidosis; autopsy
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.1130-22

Pulmonary sarcoidosis may occasionally present with large bullae, but the clinical implications of this finding remain unclear. We herein report the complete clinical course of a case of pulmonary bullous sarcoidosis. Chest computed tomography initially showed subpleural and peribronchovascular lung opacities, and bullae spontaneously developed in adjacent less-affected regions, probably via a retraction mechanism. Bullae progression was refractory to corticosteroid treatment and associated with deterioration of respiratory symptoms. The later phase involved repeated bacterial and fungal infections of the bullous lungs, eventually causing respiratory failure and mortality. Postmortem examinations revealed aggressive pulmonary Mycobacterium avium infection and diffuse alveolar damage.