Sarcoidosis With Pulmonary and Bone Marrow Involvement Following Chemotherapy in a Cancer Patient

Sarcoidosis is a multisystem granulomatous disease that rarely involves the bone marrow and is particularly uncommon during chemotherapy. A 56-year-old Japanese woman with stage IIIc fallopian tube carcinoma developed persistent high-grade fever and new bilateral pulmonary nodules two weeks after paclitaxel-carboplatin and bevacizumab therapy, which was complicated by neutropenia. Initial evaluations, including imaging, microbiological studies and bronchoscopy, excluded infection and malignancy recurrence. Histological analysis of bone marrow and transbronchial lung biopsy specimens demonstrated non-caseating granulomas, confirming sarcoidosis despite normal serum angiotensin-converting enzyme levels and absence of lymphadenopathy. Her fever and pulmonary nodules resolved spontaneously without corticosteroid therapy. This case underscores the importance of considering sarcoidosis in the differential diagnosis of fever and new pulmonary lesions in patients undergoing chemotherapy. Early histopathological confirmation is essential to avoid misdiagnosis and guide appropriate management.