Necrotizing Sarcoid Granulomatosis: Another Great Imitator

Sarcoidosis with a necrotizing sarcoid granulomatosis (NSG) pattern is a rare disease that shares similar findings with sarcoidosis and is considered a distinct variant. However, the histological presence of necrosis may lead to misdiagnosis and a delay in treatment. We report the case of a 56-year-old Caucasian woman with cough, fatigue, dyspnea with lymphadenopathy, and consolidations on a CT scan. Histological examinations and a wide spectrum of diagnostic investigations, which excluded other infectious and non-infectious causes as well as malignancy, confirmed the diagnosis of sarcoidosis with an NSG pattern. Treatment with corticosteroids initially led to the regression of symptoms. However, the treatment had to be discontinued after a manifestation of corticosteroid-induced psychosis. The reintroduction of corticosteroids at a reduced dose was well tolerated and resulted in a good clinical and imaging response. Sarcoidosis with an NSG pattern must be distinguished from other systemic and infectious diseases. As emphasized in this report, a rigorous diagnostic workup is mandatory to establish the diagnosis. Although corticosteroids are considered the treatment of choice, possible side effects and dosage adjustments should be evaluated regularly.