Pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid: a case report

Journal of Medical Case Reports

Fumio Imamura²  Kazumi Nishino²  Junji Uchida²  Takako Inoue²  Yasuhiko Tomita¹  Toru Kumagai² 

[1] Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi Higashinari-ku, Osaka 537-8511, Japan;Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi Higashinari-ku, Osaka 537-8511, Japan

关键词: Thoracentesis;    Sarcoidosis;    Pleural sarcoidosis;    Pleural effusion;    CD4/CD8 lymphocyte ratio;   

Others  :  1231399
DOI  :  10.1186/s13256-015-0656-y

 received in 2014-12-21, accepted in 2015-07-17,  发布年份 2015

【 摘 要 】

Introduction

Pleural effusion induced by sarcoidosis is rare, and pleural sarcoidosis is often diagnosed by thoracoscopic surgery. The diagnosis of pleural sarcoidosis using thoracentesis may be less invasive when sarcoidosis is already diagnosed histologically in more than one organ specimen. Here we report the case of a 64-year-old woman with pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis. This case report is important because it highlights the usefulness of the CD4/CD8 lymphocyte ratio in pleural effusion as an indicator of pleural involvement of sarcoidosis.

Case presentation

A 64-year-old Japanese woman visited our hospital with an initial symptom of dyspnea on exertion for a period of 4 months. Chest computed tomography showed bilateral hilar and multiple mediastinal lymphadenopathy, multiple small nodular shadows in her bilateral lungs, small nodular shadows along the interlobar pleura, and bilateral pleural effusion. Her serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels were elevated. Histological analysis of a resected subcutaneous nodule, and biopsy specimens from a right mediastinal lymph node and from her right lung revealed non-caseous epithelioid granulomas. Her bronchoalveolar lavage fluid exhibited a predominance of lymphocytes together with an increase in the CD4/CD8 lymphocyte ratio. The lymphocytic predominance and the increased CD4/CD8 lymphocyte ratio were also detected in the right-sided pleural effusion fluid obtained by thoracentesis. We diagnosed sarcoidosis with pleural involvement. Because pleural effusion did not resolve spontaneously and her symptom of dyspnea on exertion worsened, corticosteroid therapy was initiated, which ameliorated the sarcoidosis and the pleuritis.

Conclusions

Analysis of the CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis may be helpful for the diagnosis of pleural sarcoidosis when the diagnosis is already made by histological examination of more than one organ specimen.

【 授权许可】

   
2015 Kumagai et al.

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【 参考文献 】

• [1]Hunninghake GW, Costabel U, Ando M, Baughman R, Cordier JF, du Bois R et al.. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis. 1999; 16:149-73.
• [2]Miyoshi S, Hamada H, Kadowaki T, Hamaguchi N, Ito R, Irifune K et al.. Comparative evaluation of serum markers in pulmonary sarcoidosis. Chest. 2010; 137:1391-7.
• [3]Huggins JT, Doelken P, Sahn SA, King L, Judson MA. Pleural effusions in a series of 181 outpatients with sarcoidosis. Chest. 2006; 129:1599-604.
• [4]Soskel NT, Sharma OP. Pleural involvement in sarcoidosis. Curr Opin Pulm Med. 2000; 6:455-68.
• [5]Suzuki J, Tomizawa Y, Yoshii A, Tsuchiya T, Tsurumaki H, Iijima H et al.. A case of sarcoidosis with bilateral pleural effusion treated with high-dose steroids. Nihon Kokyuki Gakkai Zasshi. 2011; 49:287-92.
• [6]Hou G, Wang W, Zhao YB, Su XM, Wang QY, Li ZH et al.. Bloody pleural effusion-a rare manifestation of sarcoidosis. Intern Med. 2013; 52:1211-5.
• [7]Akçay S, Pinelli V, Marchetti GP, Tassi GF. The diagnosis of sarcoidosis pleurisy by medical thoracoscopy: report of three cases. Tuberk Toraks. 2008; 56:429-33.
• [8]Watarai M, Yazawa M, Yamanda K, Yamamoto H, Yamazaki Y. Pulmonary sarcoidosis with associated bloody pleurisy. Intern Med. 2002; 41:1021-3.
• [9]Ohba H, Miwa S, Shirai M, Suda T, Hayakawa H, Chida K. A case of relapsing sarcoidosis with pleurisy 14 years after spontaneous remission. Nihon Kokyuki Gakkai Zasshi. 2010; 48:632-5.
• [10]Cohen M, Sahn SA. Resolution of pleural effusions. Chest. 2001; 119:1547-62.
• [11]Nicholls AJ, Friend JA, Legge JS. Sarcoid pleural effusion: three cases and review of the literature. Thorax. 1980; 35:277-81.
• [12]Gupta BK, Bharat V, Bandyopadhyay D. Role of adenosine deaminase estimation in differentiation of tuberculous and non-tuberculous exudative pleural effusions. J Clin Med Res. 2010; 20:79-84.
• [13]Zerler B. The soluble interleukin-2 receptor as a marker for human neoplasia and immune status. Cancer Cells. 1991; 3:471-9.
• [14]Aguiar LM, Antonangelo L, Vargas FS, Zerbini MC, Sales MM, Uip DE et al.. Malignant and tuberculous pleural effusions: immunophenotypic cellular characterization. Clinics. 2008; 63:637-44.