Sarcoidosis with a Necrotizing Sarcoid Granulomatosis Pattern Presenting as Persistent Low-Grade Fever: A Case Report

Necrotizing sarcoid granulomatosis (NSG), now referred to as "sarcoidosis with NSG pattern," is an uncommon variant of sarcoidosis. NSG is characterized by a trio of features: sarcoid granulomas, vasculitis, and extensive areas of necrosis. Symptoms can include cough, fever, chest pain, an...

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Bibliographic Details
Published in:Journal of the Korean Society of Radiology 2024, 85(5), , pp.948-953
Main Authors: Kang, Se Ri, Choi, Keum Ha, Rho, Ji Young
Format: Article
Language:English
Subjects:
case report
granuloma
multiple pulmonary nodules
sarcoidosis
Thoracic Imaging
vasculitis
방사선과학
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Summary:Necrotizing sarcoid granulomatosis (NSG), now referred to as "sarcoidosis with NSG pattern," is an uncommon variant of sarcoidosis. NSG is characterized by a trio of features: sarcoid granulomas, vasculitis, and extensive areas of necrosis. Symptoms can include cough, fever, chest pain, and dyspnea, typically presenting as either solitary or multiple lung nodules or masses. In this report, we describe a case of NSG accompanied by a persistent low-grade fever. Unlike the dominant presentation of NSG with single or multiple nodules, our case demonstrated diffuse micronodules with combined perilymphatic and random distribution on CT. Histological examination revealed widespread necrotizing granulomas surrounded by anthracotic pigmentation, alongside necrosis and vasculitis, diverging from the classic presentation of sarcoidosis. The diagnosis of NSG was established through a multidisciplinary discussion. The patient was administered oral prednisolone that led to noticeable clinical and radiological improvement within three months.
ISSN:2951-0805
2951-0805
DOI:10.3348/jksr.2024.0007