Recurrent sarcoidosis after lung transplantation.

A 43-year-old man had undergone bilateral lung transplantation 2 years previously for sarcoidosis stage 4 fibrocystic disease. The patient feels well, without significant symptoms, sputa, cough or fever. A control spirometry however showed a highly obstructive, mildly restrictive pulmonary function, with a very low diffusion capacity. Laboratory results revealed a CRP of 6.4 mg/l (nl <= 5 mg/l), ferritin of 669 μg/l (nl 200-400 μg/l) and otherwise normal results. Ferritin is also an acute phase reactant, and in this case a significant elevation indicates an inflammatory state. A high-resolution CT of the lungs was performed, which shows numerous centrilobular micronodules in a perilymphatic distribution pattern (subpleural, peribronchovascular), most pronounced in the upper lungs (axial images A, B and coronal image C). Additional pulmonary biopsy revealed recurrence of sarcoïdosis.