PMC8885599_01
(A-C) Partial images of positron emission tomography-CT scan in 2017. (A) Mediastinal lymph nodes enlargement (tracheal carina) SUV max = 18.39; (aortopulmonary window) SUV max = 18.93. (B) Hilar lymph nodes enlargement. (C) Markedly enlarged spleen.
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F1
He received a positron emission tomography-CT scan to identify whether it was benign or malignant, which revealed multiple enlarged lymph nodes with hypermetabolism in the bilateral hilum, mediastinum, axilla, and clavicle, and lymphoma could not be excluded (Figure 1).
Biopsy of the left supraclavicular lymph node showing non-caseating granulomas (circle).
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F2
This result was in accordance with sarcoidosis (Figure 2).
Pleural biopsy showing non-caseating granulomas (circle).
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F3
Histological analysis of the pleura obtained by thoracoscopy also revealed granulomas (Figure 3).
Biopsy taken from the left leg ulceration also showing granulomas (circle).
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F4
In addition, a biopsy was taken from the left leg ulceration also revealed granulomas with a negative mycobacterium genetic test and culture results of fungi and bacteria (Figure 4).
(A-D) Representative CT cuts of the thorax during the course of the disease. (A) Chest CT in 2017. (B) Pre-glucocorticoid therapy (September 29, 2020, chest CT). (C) One month after glucocorticoid therapy (November 25, 2020, HRCT). (D) Six months after glucocorticoid therapy (March 20, 2021, HRCT). (E) Nine months after glucocorticoid therapy (June 30, 2021, chest contrast-enhanced CT). CT, computed tomography; HRCT, high resolution computed tomography.
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F5
HRCT showed that the bilateral pleural effusion was significantly less than before (Figure 5). Hepatic function (Figure 6) and superficial lymph nodes and spleen were reduced.
(A-C) The change of hepatic function (ALP, alkaline phosphatase; GGT, gamma glutamate transpeptidase; ALB, albumin; ALT, alanine transaminase; AST, aspartate transaminase).
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F6
HRCT showed that the bilateral pleural effusion was significantly less than before (Figure 5). Hepatic function (Figure 6) and superficial lymph nodes and spleen were reduced.
Effects of glucocorticoid on hematological parameter.
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F7
After methylprednisolone administration (the dosage was still 16 mg/day) for 9 months, the patient became asymptomatic with a normal blood cell count (Figure 7), and the CD4+ T cell count increased from 82 to 162.
(A,B) The change in leg skin. (A) Pre-glucocorticoid therapy (September 13, 2020). (B) Nine months after glucocorticoid therapy (June 30, 2021).
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F8
In addition, the leg skin ulcers and scabs completely disappeared (Figure 8).