NECROTIZING SARCOID GRANULOMATOSIS WITH PLEURAL INVOLVEMENT - CLINICAL AND RADIOGRAPHIC FEATURES

The clinical, functional, radiologic, and pathologic characteristics o f seven cases of necrotizing sarcoid granulomatosis (NSG) are presente d. The population consisted of five women and two men, with an average age of 36 years. Each patient's predominant presenting complaint was pleuritic chest pain. Pulmonary function testing demonstrated a variet y of abnormal patterns. Computed tomography (CT) of the chest showed s olitary or multiple nodules in all patients, occasionally associated w ith pulmonary infiltrates in the lower lobes. Pleural involvement was seen on CT scanning in six patients and mediastinal adenopathy was pre sent in five. Biopsy specimens of the lung lesions revealed confluent epithelioid granulomata associated with necrosis and vasculitis. Pleur al involvement by confluent granulomata was a prominent feature in fou r patients. Follow-up has ranged from 6 months to 4 years. All patient s are now asymptomatic, the majority having received prednisone. One p atient received methotrexate as a steroid-sparing measure. We conclude that NSG is distinguishable from sarcoidosis as a clinicopathologic e ntity in which pleural involvement is a frequent finding. Treatment wi th steroids appears to hasten recovery.