Tuberc Respir Dis.  2007 Feb;62(2):119-124. 10.4046/trd.2007.62.2.119.

A Case of Successful Management of Sarcoidosis with Chylothorax Using Octreotide

• Jung KS
• Moon JA
• Yoon SH
• Byun MK
• Jung WY
• Jung JH
• Choi SB
• Kim DJ
• Pyo JY
• Kim YS
• Kim SK
• Chang J
• Kim SK
• Park MS

• KMID: 2114598
• DOI: http://doi.org/10.4046/trd.2007.62.2.119

Abstract

Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea. Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed. We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid. We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid.

Keyword

Sarcoidosis; Chylothorax; Pleural involvement; Octreotide; Mediastinoscopy

MeSH Terms

Adrenal Cortex Hormones
Biopsy
Chylothorax*
Cough
Cytotoxins
Dyspnea
Female
Granuloma
Humans
Injections, Subcutaneous
Korea
Ligation
Lymphatic Diseases
Mediastinoscopy
Middle Aged
Octreotide*
Pleural Effusion
Pleurodesis
Radiography, Thoracic
Sarcoidosis*
Talc
Thoracic Duct
Adrenal Cortex Hormones
Cytotoxins
Octreotide
Talc

Figure

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  Figure 1 A) High resolution computed tomography (HRCT) scan taken before mediatinoscopic biopsy, showed multiple enlarged or non enlarged and conglomerated lymph nodes at both hilum and mediastinum. B) HRCT scan taken after octreotide and prednisolone treatment of 3 weeks, showed a complete resolution of right pleural effusion and a decrease of multiple lymphadenopathy at both hila and mediastinum.

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  Figure 2 A) Chest X-ray taken after mediastinoscopic biopsy of 1 month, showed a right pleural effusion. B) Chest X-ray taken after octreotide and prednisolone treatment of 3 weeks, showed a complete resolution of right pleural effusion.

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  Figure 3 Microscopic examination of samples by mediastinoscopic biopsy showed chronic granulomatous inflammations without caseous necrosis which consistent with sarcoidosis (A: H & E, ×40, B; H & E, ×200)

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