A Case of Sarcoidosis Beginning with Extensive Ground-Glass Pattern on Chest X-ray, Accompanied with High Fever and Eosinophilia

: A 62-year-old woman was admitted to our hospital with a chief complaint of dyspnea on effort. Her temperature was 38 approximately 39 degrees C. Eosinophilia was seen in peripheral blood and the chest roentgenogram showed bilateral extensive ground-glass pattern, accompanied by air bronchogram. The extensive shadow fitted the description of "unstable shadow." Transbronchial lung biopsy specimens demonstrated the formation of non-caseating epithelioid cell granulomas with severe alveolitis and exudative change in alveolar spaces. In bronchoalveolar lavage fluid (BALF), the total cell count was normal but the lymphocyte population was increased to 28%. Pathological findings were suggestive of either sarcoidosis or hypersensitivity pneumonitis. Prednisolone therapy was started. As a result, her symptoms rapidly disappeared and the chest roentgenogram showed remarkable improvement for a short period. However skin lesions on bilateral lower extremities appeared after approximately one month from discontinuation of prednisolone. Skin biopsy specimens showed non-caseating epithelioid cell granulomas leading to the final diagnosis of sarcoidosis. About one month after the appearance of the skin lesion, the chest roentgenogram findings deteriorated. At this time, the BALF eosinophil population surprisingly increased to 24.9%. Chest roentgenogram showed rapid improvement again by administration of prednisolone. This case was considered to be a unique case of sarcoidosis from the point of view of the chest roentgenogram pattern, eosinophilia, clinical course and presence of severe alveolitis with exudative change in alveolar spaces.