Sarcoidosis involvement of the diaphragm leading to right diaphragmatic elevation: a case report

Sarcoidosis involvement of the diaphragm leading to right diaphragmatic elevation: a case report

Authors

  • Tina Schreiber Lungenklinik Köln Merheim
  • Michael Brockmann
  • Axel Goßmann
  • Nils Juriaan Kosse
  • Erich Stoelben
  • Wolfram Windisch

Keywords:

Sarcoidosis, Lymphocytic myositis, Diaphragmatic paresis, Non-caseating epitheloid granulomas

Abstract

A 69-year-old male Caucasian presenting with dyspnea on exertion related to unilateral diaphragmatic dysfunction as caused by sarcoidosis is described. First, right diaphragmatic elevation was unexplained, while the patient presented with a restrictive pattern in lung function testing using bodyplethysmography and with reduced global and diaphragmatic respiratory muscle strength as evidenced by respiratory pressures. Subsequently, surgical diaphragm duplication was performed, unfortunately, without any clinical improvement. Microscopic examination of diaphragm sections revealed a lymphocytic myositis with granulomatous pleuritis showing multiple non-caseating epithelioid granulomas. Accordingly, a lymphocytic alveolitis (26% lymphocytes) with an elevated CD4/CD8 T cell ratio of 8.0% and elevated serum parameters (neopterine and sIL-2 receptor) were established. Consequently, the diagnosis of pulmonary sarcoidosis with diaphragm involvement but without extrapulmonary involvement has been established.

Therefore, sarcoidosis needs to be considered in any patient presenting with unilateral diaphragmatic dysfunction. The optimal treatment strategy, however, needs to be established in the future.

Author Biography

Tina Schreiber, Lungenklinik Köln Merheim

1 Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Faculty of Health/School of Medicine, Witten/Herdecke University, Cologne, Germany;

2 Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany

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Published

28-06-2021

Issue

Section

Case Reports

How to Cite

1.
Schreiber T, Brockmann M, Goßmann A, Kosse NJ, Stoelben E, Windisch W. Sarcoidosis involvement of the diaphragm leading to right diaphragmatic elevation: a case report. Sarcoidosis Vasc Diffuse Lung Dis [Internet]. 2021 Jun. 28 [cited 2025 May 21];38(2):e2021011. Available from: https://mattioli1885journals.com/index.php/sarcoidosis/article/view/8042