BILATERAL INGUINAL LYMPHADENOPATHY AS THE EXTRAPULMONARY PRESENTATION OF PULMONARY SARCOIDOSIS: A RARE CLINICAL PRESENTATION

TOPIC: Diffuse Lung Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sarcoidosis is a multi-systemic granulomatous disorder of unknown etiology and characterized pathologically by the presence non-caseating granulomas in involved organs; particularly lungs, hilar lymph nodes, skin, eyes. affects individuals any age, sex race but it commonly young to middle-aged, Black American adults. The diagnosis sarcoidosis made on basis clinical features with compatible radiological findings further supported histological evidence affected organs, exclusion other disorders that may present similarly. Biopsy usually recommended for all patients are suspected having exception Lofgren's syndrome, Heerfordt syndrome Lupus Pernio. Extra-pulmonary nodes 15% patient's at time diagnosis. We female who presents bilateral inguinal lymphadenopathy as first sign CASE PRESENTATION: A 32 year old presented complaints bilateral, non-tender, swellings progressively enlarged over two week period. This was accompanied five pounds weight loss which she attributed decreased appetite due personal stressors. She had no associated fever, chills, vaginal discharge, dyspnea, cough, arthralgia or rashes. Physical examination revealed multiple, palpable, mobile varying sizes bilaterally overlying skin changes. hepatomegaly, splenomegaly uveitis. erythrocyte sedimentation rate 34 mm/hr (<25 mm/hr), 25 hydroxy-vitamin D 13.5 ng/mL (30.0-80.0 ng/mL) serum angiotensin converting enzyme level 259 U/L (9.0-47.0 U/L). Abdomen pelvic computed tomography showed measuring up 1.6 cm short axis. Chest bulky mediastinal adenopathy axillary lymphadenopathy. There were multifocal clusters peri-lymphatic lung nodules lungs. Excisional biopsy right node lymphadenitis. Acid fast bacilli (AFB) stain negative acid organisms. DISCUSSION: While extra-pulmonary manifestations common, remains rare presenting complaint few documented cases. finding suggests peripheral an effort establish granulomas, appropriate radiographic presentation, viable minimally invasive method diagnosing sarcoidosis. CONCLUSIONS: differential should include systemic conditions such REFERENCE #1: Baughman, RP, Teirstein, AS, Judson, MA, et al. Clinical characteristics case control study Am J Respir Crit Care Med 2001; 164: 1885–1889. #2: Monnet P, Thevenon J. clinically isolated adenopathy; confirmed & pre-scalenic nodes. Lyon 1959;91:191-5. #3: Iannuzzi MC, Rybicki BA, Teirstein AS (2007) Sarcoidosis. N Engl 357(21):2153–2165. DISCLOSURES: No relevant relationships Sai Achi, source=Web Response Raji Ayinla, Janet Joseph, Richard Sheppard,