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Machida H.,National Hospital Organization National | Shinohara T.,National Hospital Organization National Kochi Hospital | Hatakeyama N.,National Hospital Organization National | Okano Y.,National Hospital Organization National | And 7 more authors.
Japanese Journal of Chest Diseases | Year: 2011

The patient was a 68-year-old asymptomatic female with obscure infiltration in the right upper lung field in the postoperative follow-up for gastric cancer. Although her chest X-ray and CT findings suggested mycobacterium infections, bronchoscopic evaluation could not provide additional information for diagnosis. After 8 months, radiological abnormalities changed for the worse and histological examination of a transbronchial lung biopsy indicated granulomatous formations. However, culture and PCR for detection of mycobacterium and QFT test were negative. The patient also did not meet diagnostic criteria for sarcoidosis at that time. Although, thoracoscopic lung biopsy was performed and confirmed non-necrotizing granulomas, the result was not sufficient to make a definite diagnosis. More than 8 months later, biopsy of skin lesions which appeared as erythema nodosum in the lower extremities provided the final diagnosis of sarcoidosis. Type III sarcoidosis without abnormal laboratory findings is clinically difficult to distinguish from mycobacterium infections. Aggressive biopsy is necessary for diagnosis of persistent unusual shadow on chest radiographs.

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