Refractory sarcoidosis presenting as chylothorax: a case report

Sarcoidosis is a systemic granulomatous autoinflammatory disease that primarily affects lymphoid organs, the skin, and the lungs. While recurrent pleural effusion is documented in sarcoidosis, chylothorax is exceedingly rare. We present a male patient in his seventies who presented to the emergency department with long-standing fatigue, a ten-kilogram weight loss over six months, new-onset snoring, and nasal congestion. Evaluations, including respiratory function tests and chest computed tomography, revealed findings consistent with sarcoidosis, such as hilar lymphadenopathy, reduced carbon monoxide diffusion, and elevated serum angiotensin-converting enzyme levels, along with pleural effusion. Analysis of the pleural fluid showed it to be exudative, with high triglycerides level. We concluded that chylothorax resulted from extensive lymph node involvement. During two years of follow-up, combinations of methylprednisolone and other immunosuppressants were ineffective, leading to disease progression. Infliximab was then initiated, resulting in a dramatic clinical response and improvement in Positron Emission Tomography/Computerized Tomography (PET/CT) imaging.