Fleeting pneumonia in a child: Necrotizing sarcoid granulomatosis

Abstract

An 8-year-old boy presented with history of recurrent fever, chest pain, and occasional dry cough since the age of 5 years. There was recent onset of oral aphthous ulcers without any breathlessness or activity limitation. His anthropometry parameters were preserved. He never required any oxygen support. Chest X-rays showed fleeting opacities involving left lung mainly and computed tomography showed necrotizing pneumonia of the left upper lobe. Open lung biopsy was suggestive of necrotizing sarcoid granulomatosis. Angiotensin converting enzyme (ACE) was elevated. He responded to steroid and was started on azathioprine in view of recurrence of symptoms following tapering of steroid. Currently, he is under follow-up with normal ACE level.