Different Performance and Prognosis for a Familial Case of Sarcoidosis in China: Novel Insight from Clinical Practice

Case Report

Austin J Pulm Respir Med 2015; 2(3): 1033.

Different Performance and Prognosis for a Familial Case of Sarcoidosis in China: Novel Insight from Clinical Practice

Lei Liu¹* and Bin Liu²

¹Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, China

²Department of Respiratory Medicine, The First Affiliated Hospital of Harbin Medical University, China

*Corresponding author: Lei Liu, Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, No.37, Yi Yuan Street, Nan Gang District, Harbin 150001, China

Received: October 10, 2015; Accepted: November 17, 2015; Published: November 19, 2015

Abstract

Sarcoidosis is a common multi-system disease characterized histolopathologically by the formation of non-caseating granulomas in the affected tissue. Hereditary susceptibility to sarcoidosis is suggested by ethnic preponderance, familial clustering, and multigenerational involvement, but the genetics of sarcoidosis do not be adequately confirmed, so do the living environment, especially in china. This report presents a 55-year-old woman with blood-tinged sputum and exertional dyspnea. The clinical, laboratory examination and pathology revealed that the patient had sarcoidosis (stage II). Appropriate therapy was administered, and the patient symptom and sign were improved significantly. Her son was a patient with pulmonary sarcoidosis (stage II) contemporarily, however, no symptom and sign were revealed and self-healing happened. Her mother was a patient with pulmonary fibrosis which caused by sarcoidosis in family history, although appropriate therapy was given, but the patient symptom and sign were not improved significantly, her mother died because of serious lung fibrosis and combined infection. Nothing living environment and infection factors were found. There were different performance and prognosis for a Chinese family case of genetic predisposition sarcoidosis and the same disease remain needs individualized treatment.

Keywords: Sarcoidosis; Non-caseating granulomas; Individualized treatment

Introduction

Sarcoidosis is a common multi-granulomatous disease that is characterized by the formation of non-caseating epithelioid cell granulomas in various tissues and organs. The first case of sarcoidosis described in literature was by Hutchinson in 1875 year [1]. The sarcoidosis mainly affects the lungs, lymph nodes, liver, and spleen, and less frequently the eyes, bones and skin [1-3]. Sarcoidosis have a tendency of genetic disease, in the USA, there is significant racial variation in the incidence rate, with 10-14 cases per 100,000 for caucasians and 35.5-64 cases per 100,000 for African-Americans [4], the familial case report becomes a very rare finding in china, furthermore, the etiology has not been confirmed. There is a slightly higher incidence in females [4].

Case Report

We report the Chinese case of a 55-year-old (60 Kg) woman who had had chronic productive cough with blood-tinged sputum and exertional dyspnea for one year. She was a lifelong non-smoker, currently unemployed, and occasionally homeless. Nothing to be declared in her past medical history. Her son (30-year-old) was a patient with pulmonary sarcoidosis (stage II) contemporarily, however, no symptom and sign were revealed in her son, sarcoidosis was discovered by chest Computed Tomography (CT) and confirmed by bronchoscopic with biopsy tissue pathology 6 months, and selfhealing happened by chest CT in her son 3 months ago.

On examination, she was ill-appearing but in no acute distress. Her axillary temperature was 36.5oC; blood pressure was 130/80mm Hg with a normal heart rate of 80 bpm, and oxygen saturation SpO2: 95%. Lung auscultation revealed crackles over the lower right lung.

On laboratory testing, the patient had a normal level white blood cell count of 8,300 cells/uL; the hemoglobin level was 133 g/L. The erythrocyte sedimentation rate was 25 mm after the first hour. Hepatitis virus was negative. Nothing was abnormal in liver and renal function. Nothing was found about autoantibody examination and rheumatic test.

There was no lymphadenopathy observed in general examination, but chest CT demonstrated right hilar prominence, and hilar lymphadenopathy, and bilateral lower lung lobe infiltration opacification (Figure 1). In addition, bronchoscopic biopsy was conducted as a diagnostic approach.