Sarcoidosis Beyond the Lungs: A Rare Case of Splenic Involvement

Sarcoidosis, a rare inflammatory multisystemic disease more prevalent among females, is characterised by noncaseating granulomas affecting organs like the lungs, liver, lymph nodes, skin, and eyes. Diagnosis is through exclusion, ruling out infections, malignancies, and environmental factors. It involves an inflammatory response in a genetically susceptible host. Clinical presentations range from asymptomatic to organ failure, including skin lesions, ocular manifestations, and neurological involvement. Granuloma formation is the pathological hallmark, and chest radiograph using Scadding staging is common for the diagnosis of pulmonary sarcoidosis. A rare case of splenic involvement in sarcoidosis is presented in a 50-year-old diabetic, hypertensive, and hypothyroid female. She reported significant weight loss, decreased appetite, generalised weakness, bilateral knee and ankle pain, fever, dry cough, chest pain, exertional breathlessness, neck swelling, and maculopapular lesions on her upper limbs. Examination revealed palpable cervical lymph nodes (1.5×1 cm) and hepatosplenomegaly. Investigations showed microcytic hypochromic anaemia, hypokalaemia, elevated alkaline phosphatase, and bilateral hilar lymphadenopathy on chest X-ray. Tests for tuberculosis and connective tissue disorders were negative. Elevated serum calcium and angiotensin-converting enzyme (ACE) levels, along with noncaseating granulomas on lymph node and skin biopsies, confirmed sarcoidosis. Computed tomography (CT) scans revealed hepatomegaly with liver and spleen lesions and enlarged lymph nodes in the mediastinum, bilateral axillae, para aortic, aorto-caval, and bilateral inguinal locations. The patient received symptomatic treatment, followed by oral steroids and methotrexate with folic acid supplementation. She improved symptomatically and was discharged with instructions for regular follow-up. Prompt identification of sarcoidosis is crucial, as it often goes undetected, its closest mimic being tuberculosis. Treatment starts with steroids and may include immunosuppressive or anti-tumour necrosis factor (anti-TNF) alpha agents, significantly benefiting the patient.