Correct!
3. Sarcoidosis
The biopsy shows normal lung with a nodule consisting of a granuloma without necrosis. The lung presentation and the biopsy are characteristic of nodular sarcoidosis (3).
Nodular sarcoidosis is an uncommon presentation of the disease. Malaisamy et al. (4) reported 33 cases of nodular sarcoidosis. The patients were predominantly young (mean age 35), female (28/33), and all were African-American. Extrapulmonary involvement was seen in 14 (liver 6, skin 5, eyes 5, heart 1, other 4). Mediastinal adenopathy was present in 30/33, upper lobe involvement 27, pleural-based masses 20, and pleural effusion in 11. Corticosteroid treatment was given in 27 cases with good radiologic response in 19. Only one case progressed to pulmonary fibrosis.
Symptomatic neurosarcoidosis occurs in perhaps 5% of sarcoidosis patients (5). Imaging (MRI) abnormalities are reported in 10%. Neurologic symptoms are the initial clinical manifestation in 50 to 70% of cases of neurosarcoidosis. Cranial neuropathies are the most common manifestation of neurosarcoidosis, typically a facial nerve palsy. Isolated cranial neuropathies typically resolve. Multiple neuropathies typically have a chronic course
This patient was treated with corticosteroids and had an excellent response with resolution of her symptoms.
References