Cold Miliary: An Atypical Presentation of Thoracic Sarcoidosis - Abstract
Sarcoidosis is an idiopathic systemic granulomatous disease of unknown etiology, characterized by fibrotic changes in tissue architecture and specifically by the presence of non-caseating epithelioid cell granulomas. We report the case of a cold miliary pattern diagnosed as atypical thoracic sarcoidosis, focusing on the challenges in establishing the diagnosis. The patient is a 38-year-old woman treated for lymph node tuberculosis at the age of 12. She presented with progressive dyspnea over one year, accompanied by a persistent dry cough, general health deterioration, and anxiety. An anti-tuberculous treatment was initiated empirically without bacteriological evidence, showing no improvement by the end of therapy. Subsequently, a chest CT scan revealed diffuse micronodules with a lymphatic distribution, associated with bilateral hilar and mediastinal lymphadenopathy. Bronchial biopsies showed non-necrotizing, non-caseating tuberculoid granulomatous inflammation. Angiotensin-converting enzyme (ACE) levels were elevated, and the 6-minute walk test revealed
desaturation to 90% after a distance of 30 meters. A multidisciplinary team discussion concluded with the diagnosis of atypical thoracic sarcoidosis. The patient was started on corticosteroid therapy combined with adjuvant treatment for 14 months, showing favorable progression confirmed by a follow-up chest CT scan six months later.