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Pulmonary puzzle
Fever, splenomegaly and lymphopenia in sarcoidosis
  1. Claudia Ravaglia1,
  2. Carlo Gurioli1,
  3. Gian Luca Casoni1,
  4. Silvia Asioli2,
  5. 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}gmail.com

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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 …

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