Oldest case of sarcoidosis in the world.

Oldest case of sarcoidosis in the world Acute sarcoidosis in an octogenarian is rare. In this case bone-mnarrow trephine biopsy uncovered an unsuspected diagnosis. Case report An 81-year-old spinster presented with a six-month history of anorexia, weight loss of 6-35 kg, and lower abdominal distension which was always relieved by an episode of diarrhoea. The only other symptoms were night sweats and nocturnal leg cramps, both of which had lasted for one month. Her history included Bell's palsy at the age of 70, a severe epistaxis requiring hospital admission when she was 79, and longstanding congestive cardiac failure, which had been controlled by digoxin and diuretics. These were her only medications. On examination she had no fever, there were palpable mobile lymph glands in both axillas and both inguinal regions, her liver was enlarged 3 cm below the costal margin, but her spleen was not palpable. She had a persisting partial right facial nerve palsy. Chest x-ray examination showed bilateral hilar lymphadenopathy. The result of the Mantoux test was negative with 10 IU of purified protein derivative. Haemoglobin concentration was 12-5 g/dl; mean cell volume 81 fl; white blood count 10-9 x 1012/1, with a slight lympho-cytosis; erythrocyte sedimentation rate 84 mm in the first hour; urea and electrolytes normal. Serum aspartate aminotransferase activity was transiently raised up to 31 IU but returned to normal without changes in the electro-cardiogram. Serum protein concentration was 95 g/l, and electrophoresis showed decreased x,-globulin with increased gammaglobulin. Serum and 24-hour urinary calcium concentrations were normal. Results of respiratory function tests were as follows: forced vital capacity 1-5 1, forced expiratory volume in 1 s 1-01, transfer factor reduced at 2-0 mmol/min/kPa (6-0 ml/min/ mm Hg) (predicted value 6-4 mmol/min/kPa (19-0 ml/min/mm Hg)). Ophthalmological examination, including slit-lamp inspection and lacrimal gland secretion, showed no abnormality. X-ray examinations of the hands and feet showed them to be within normal limits for age. Tissue for histo-logical examination was obtained in the first instance by Jamshidi trephine bone-marrow biopsy. This showed scanty normal marrow elements with depleted iron stores and multiple non-caseating granulomas (see figure). Sections of a biopsied axillary lymph node showed multiple small non-caseating epithelioid and giant-cell granulomas. The result of the Kveim test (Colindale K19 type 1 lot 9) was strongly positive on histological examination. Comment The patient was found to have peripheral lymphadenopathy and bilateral hilar lymphadenopathy. The symptoms of night sweats led …