Difficult Diagnosis in a Case of Pulmonary and Peritoneal Sarcoidosis

Pulmonary and associated peritoneal sarcoidosis is a rare presentation. A 49-year-old man presented with persistent cough and exertional dyspnoea. Following radiological and pathological investigations he was diagnosed with pulmonary fibrosis related to previous dust exposure in the textile industry. Histology was reported to show chronic inflammation, fibrosis, and foreign body giant cells, but no granulomas. Two years later white spots were seen on the peritoneal surface during a routine right inguinal hernia repair. These were biopsied and showed a few neat well-defined granulomata. He continued to complain of breathlessness, and was referred back to the respiratory physicians. Further investigation revealed bilateral ground glass shadowing on HRCT, and re-examination of the original transbronchial biopsy revealed further findings consistent with a diagnosis of sarcoidosis. The patient was started on oral prednisolone to good effect. This case illustrates the importance of reviewing the patient history and investigations to diagnose patients with persistent symptomatology.