Sarcoidosis Presenting as a Case of Pulmonary Thrombotic Disease- An Unusual Presentation

Abstract

Sarcoidosis is a chronic inflammatory disease involving multiple organ systems for which the inciting stimulus is unknown. It is characterized by elevated markers of inflammation and disseminated granuloma in the affected organs. Factor V Leiden deficiency has been long associated with an elevated risk of thrombosis, however, it has been observed in the patients having sarcoidosis, a secondary inciting stimulus is required to trigger the thromboembolic phenomenon, as to date only a few cases of Primary thrombosis have been reported in Factor V Leiden deficient patients culminating in an increased incidence of thromboembolic disease. We are presenting a case of a patient presenting with cerebrovascular events and pulmonary embolism, who was diagnosed later diagnosed to have sarcoidosis with an associated Protein S deficiency and factor V Leiden mutation making her predisposed to thromboembolic disease. It has been speculated that steroids as a treatment elevate the risk of thrombosis in such patients instead of the inflammatory process per se. however; this patient experienced a thrombotic episode before the start of medications. Additionally, an anatomical relationship has been reported in the literature between the site of sarcoidosis and the development of thrombosis, but the patient had repeated episodes of cerebrovascular events, despite no evidence of involvement of cranial vasculature or any heart defect, that could cause paradoxical embolization. This case report can help to elicit the relation of sarcoidosis with the increased tendency towards thromboembolic disease. CaSe RePoRt