Necrotizing Sarcoid Granulomatosis with Natural Resolution after a Surgical Lung Biopsy

Abstract

Necrotizing sarcoid granulomatosis (NSG) is a rare disease that is diagnosed based on pathological findings. We herein report the case of a 27-year-old man who had multiple nodular shadows in bilateral lung fields on chest radiography and elevated levels of C-reactive protein (CRP). The pathological evaluation of a lung biopsy specimen showed the infiltration of lymphocytes, granulomas with necrosis and granulomatous angiitis. He was therefore diagnosed with NSG. He has been followed without treatment, as his fever and CRP levels decreased immediately after the surgical lung biopsy. Thereafter, the pulmonary nodular shadows gradually recovered without any treatment within a few months. Our experience suggests the possibility that surgical invasion might trigger an improvement in disease activity.

Keywords: multiple nodular shadows; natural recovery; necrotizing sarcoid granulomatosis; surgical lung biopsy.

Figure 1.

Findings of chest radiography and computed tomography at admission. Chest radiography showing multiple nodular shadows in both lung fields and pulmonary infiltration in the left lower lung field. (B) Chest CT showing multiple nodular shadows in the bilateral lung fields. The nodular shadows had irregular margins, and some of them appeared to be infiltration.

Figure 2.

Pathological findings at the lung biopsy. (A) An evaluation of the biopsy specimen using loupe images revealed multiple granulomas. (B) The pathological findings of the lung showing granulomatous vasculitis (Hematoxylin and Eosin (H&E) staining, ×400), (C) granulomas with giant cells and necrosis (H&E staining, ×400) and (D) lung showing granulomatous bronchiolitis (H&E staining, ×100).

Figure 3.

Findings of chest radiography at six months after the diagnosis. Chest radiography and (B) chest CT at six months after the diagnosis showed improvement in the pulmonary nodular shadows.