149Lu Micronodular Sarcoidosis

  • 68yo M
    • HTN, T2DM, HLD, CKD,
    • Gleason 3+4 prostate cancer (T3aN0M0= stage IIIB)
      • Staging PET/CT
        • upper lobe predominance
        • fine interstitial thickening
        • non avid enlarged mediastinal lymph nodes
      • HRCT
        • upper lobe predominant
        • reticulonodular opacities with a possible centrilobular pattern
        • right major fissure. Given that the ddx included infectious etiologies and sarcoidosis
        • EBUS with TBNA, TBBx/EBBx
          • non-caseating granulomas and a
          • CD4/CD8 ratio of 7
          • suggestive of sarcoidosis.
        • No respiratory symptoms
        • no clear evidence of extrapulmonary organ involvement
        • CKD and nephrolithiasis
          • stone analysis revealing 80% calcium oxalate.
        • PFTs
          • normal. Hydroxychloroquine could be considered for hypercalcuria or hypercalcemia.
      • Path Final Diagnosis
      • RIGHT UPPER LOBE, TRANSBRONCHIAL BIOPSY:
        • Bronchopulmonary parenchyma with non- necrotizing granuloma,

Non Caseating Granulomas consistent with Sarcoidosis