A 38-year-old nonsmoking female presented with left-sided chest pain and dyspnea for three consecutive days. The patient was admitted to Masih Daneshvari Hospital on September 19, 2016. She had no history of fever, weight loss, and arthralgia or skin rash. Her blood pressure was 110/70 mmHg, pulse rate was 85, temperature was 37.5 C, and respiratory rate was 28. The breath sound was decreased in the left lower zone of the lung, and other physical examinations were unremarkable.
Chest radiograph manifested two pulmonary nodules and basal atelectasis in the left lower lobe with pneumothorax (Figure 1). Chest CT scan exhibited collapsed consolidation of the left lower lobe with pneumothorax and the presence of relatively two separated small-sized cystic lesions within the collapsed segment (Figure 2).
The laboratory tests revealed the increase in WBC count with predominantly neutrophils; the erythrocyte sedimentation rate and C-reactive protein were elevated. The nitroblue tetrazolium (NTB) blood test was at the 99% accuracy level. Anti-nuclear antibodies (ANAs), anti-neutrophil cytoplasmic antibodies (C-ANCA and P-ANCA), and anti-double-stranded DNA (anti-dsDNA) were negative; in addition, the anti-HIV antibody test was negative. Transparently, the pulmonary function tests showed moderately restriction.
Lung lesion resection for two intraparenchymal pulmonary nodules and cavitary lung lesion in the left lower lobe was performed; furthermore, the histological examination showed some epithelioid and giant cell granulomas with necrotizing arteritis in conjunction of a large area of necrosis (Figures 3 and 4). Acid-fast staining, periodic acid-Schiff (PAS) staining, and Gomori methenamine-silver (GMS) staining were negative; therefore, the ultimate diagnosis was necrotizing sarcoid granulomatosis. The prognosis of NSG is favorable, and medical treatment is usually not required. As a matter of fact, in our case report, the patient recovery conspicuously occurred; nevertheless, in some cases, treatment with corticosteroids is quite essential.