Thorax 68:496-497 doi:10.1136/thoraxjnl-2011-201408
  • Chest clinic
  • Pulmonary puzzle

Fever, splenomegaly and lymphopenia in sarcoidosis

Open Access
  1. Venerino Poletti1
  1. 1Department of Diseases of the Thorax, Pulmonology Unit, Pierantoni-Morgagni Hospital, Forlì, Italy
  2. 2Department of Pathology, Pierantoni-Morgagni Hospital, Forlì, Italy
  1. Correspondence to Dr Venerino Poletti, Pulmonology, Department of Thoracic Diseases, GB Pierantoni—L Morgagni Hospital, via C. Forlanini 34, 47100 Forlì, Italy; venerino.poletti{at}
  1. Contributors All authors have made important contributions in the discussion of the clinical case and drafting the article.

  • Accepted 29 January 2013
  • Published Online First 2 June 2012

Clinical presentation

A 42-year-old woman was referred to our department with a 5 months history of intermittent fever and fatigue. Her past medical history included a consolidated diagnosis of sarcoidosis (obtained 7 years before with a sub-carinal lymph node biopsy) and in the previous years she had been treated with steroids, hydroxychloroquine, methotrexate and azathioprine with persistent and progressive enlargement of mediastino-hilar adenopathies and bilateral nodular infiltrates. Her symptoms progressed despite a course of antibiotics prescribed for presumed community-acquired pneumonia and a course of corticosteroids. The patient lived in Italy and there was no history of travels or other additional risk factors for infections.

At the time of admission, the patient had a temperature of 38.5°C and the physical examination was only notable for hepatomegaly and …