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Chest radiographs did not show bilateral hilar lymphadenopathy (A). Computer tomography (CT) did not show hilar and mediastinal lymphadenopathy or reveal other significant findings in the lung area (B and C).
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Abdominal CT showed hepatosplenomegaly and renal enlargement (Fig. 1, Fig. 2).
Bone marrow biopsy showing noncaseating epithelioid granulomas(circle).
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Bone marrow biopsy revealed a large number of noncaseating epithelioid granulomas within the hematopoietic area (Fig. 3).
Liver biopsy showing small epithelioid granulomas (circle).
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Liver biopsy was performed because of hepatosplenomegaly and mild liver dysfunction, and showed non-necrotizing small epithelioid granulomas (Fig. 4).
Renal biopsy showing interstitial nephritis (A). The arrow indicates infiltration of lymphocytes in the interstitial site. High-magnification pictures show focal crescentic glomerulonephritis (B). Arrow heads indicate the crescent formation.
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Histological examination of renal biopsy sample showed tubulointerstitial nephritis and focal crescentic glomerulonephritis (Fig. 5).
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Follow-up of laboratory data.
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We increased prednisolone to 50 mg daily, after which renal dysfunction and laboratory data including CRP and lysozyme were improved (Fig. 6).