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IMAGE IN EUS
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 268-269

Mediastinal sarcoidosis diagnosed by endobronchial ultrasound in a patient with Sjögren's syndrome


1 Department of Endoscopy, French-Brazilian Centre of Endoscopic Ultrasound, São Paulo, Brazil
2 Department of Pathology, Santa Casa de São Paulo Hospital, São Paulo, Brazil

Date of Submission21-Oct-2014
Date of Acceptance16-Nov-2014
Date of Web Publication17-Aug-2015

Correspondence Address:
Dr. Augusto Carbonari
Department of Endoscopy, French-Brazilian Centre of Endoscopic Ultrasound, São Paulo
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.163022

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How to cite this article:
Carbonari A, Camunha M, Marioni F, Saieg M, Rossini L. Mediastinal sarcoidosis diagnosed by endobronchial ultrasound in a patient with Sjögren's syndrome. Endosc Ultrasound 2015;4:268-9

How to cite this URL:
Carbonari A, Camunha M, Marioni F, Saieg M, Rossini L. Mediastinal sarcoidosis diagnosed by endobronchial ultrasound in a patient with Sjögren's syndrome. Endosc Ultrasound [serial online] 2015 [cited 2019 Sep 18];4:268-9. Available from: http://www.eusjournal.com/text.asp?2015/4/3/268/163022

A 51-year-old woman with dyspnea, cough, and fever for the preceding 6 months was referred for endobronchial ultrasound (EBUS) to evaluate mediastinal lymphadenopathy. The patient had a history of Sjögren's syndrome. Conventional chest X-ray demonstrated hilar lymphadenopathy [Figure 1]. Computed tomography examination revealed calcified mediastinal lymph nodes in paratracheal and subcarinal regions [Figure 2]. The patient underwent EBUS (Fujinon Corporation, Japan) that showed enlarged calcified lymph nodes, located in subcarinal, paratracheal, and pulmonary hilum [Figure 3]. EBUS-guided transbronchial needle aspiration (EBUS-TBNA; Medi-Globe Corporation, Germany) [Figure 4] confirmed the presence of granulomatous lymphadenitis, with no necrosis [Figure 5]. Special stains (periodic acid-Schiff (PAS), Grocott, and Ziehl-Neelsen) for the detection of acid-fast bacilli and fungi were negative, suggesting the diagnosis of sarcoidosis.
Figure 1. Conventional chest X-ray showing hilar lymphadenopathy

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Figure 2. Computed tomography (CT) scan showing calcified mediastinal lymph nodes in paratracheal and subcarinal regions

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Figure 3. Endobronchial ultrasound (EBUS) showing enlarged lymph nodes located in subcarinal (7), bilateral paratracheal (4L, 4R), and pulmonary hilum (10L)

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Figure 4. EBUS-guided transbronchial needle aspiration (EBUS-TBNA) of subcarinal lymph node

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Figure 5. Histological sections of the cell block obtained by EBUS-TBNA showing noncaseating granulomas involving the lymph node. Subsequent special stains for acid-fast bacilli and fungi were negative (hematoxylin and eosin (H and E), × 40)

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Sarcoidosis is a multisystem inflammatory disease of unknown etiology that manifests as noncaseating granulomas, predominantly in the lungs and intrathoracic lymph nodes. It has different clinical manifestations and the severity of sarcoidosis involvement may range from an asymptomatic state to a life-threatening condition. The lung is the organ which is most commonly involved with sarcoidosis. The incidence and prevalence of sarcoidosis varies widely throughout the world. The highest annual incidence is observed in northern European countries (5-40 cases per 100,000 people). [1]

Association of autoimmune disorders, such as Sjögren's syndrome, can be observed in patients with sarcoidosis. [2],[3] The exact mechanism of this relation is not exactly known. The diagnosis is based on the association of a compatible clinical and radiological presentation, the presence of noncaseating epithelioidcell granulomas in the absence of other causes. [4]

Furthermore, EBUS-TBNA is a valuable tool in the diagnostic workup of patients with enlarged mediastinal lymph nodes. A recent systematic review and meta-analysis, confirms the high diagnostic performance of EBUS-TBNA for mediastinal and hilar lymphadenopathy, both in malignant and nonmalignant conditions. Available evidence also demonstrates the safety of this procedure. [5]

Thus, we could demonstrate a case of mediastinal sarcoidosis diagnosed by EBUS in a patient with an autoimmune disease (Sjögren's syndrome). EBUS was successful not only in obtaining enough material for morphological analysis but also to exclude the presence of others microorganisms by special stains.

 
  References Top

1.
Pietinalho A, Hiraga Y, Hosoda Y, et al. The frequency of sarcoidosis in Finland and Hokkaido, Japan. A comparative epidemiological study. Sarcoidosis 1995;12:61-7.  Back to cited text no. 1
    
2.
Enzenauer RJ, West SG. Sarcoidosis in autoimmune disease. Semin Arthritis Rheum 1992;22:1-17.  Back to cited text no. 2
    
3.
Deheinzelin D, de Carvalho CR, Tomazini ME, et al. Association of Sjögren's syndrome and sarcoidosis. Report of a case. Sarcoidosis 1988;5:68-70.  Back to cited text no. 3
    
4.
Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007;357:2153-65.  Back to cited text no. 4
    
5.
Chandra S, Nehra M, Agarwal D, et al. Diagnostic accuracy of endobronchial ultrasound guided transbronchial needle biopsy in mediastinal lymphadenopathy: A systematic review and meta-analysis. Respir Care 2012;57:384-91.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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