Abstract

A 38-year old female with a history of systemic lupus erythematosus on rituximab therapy, bipolar disorder, renal dysfunction, and recurrent nephrolithiasis, presented to the hospital with fevers, flank pain, 40-pound weight loss, odynophagia, and dysphagia. She was found to have new pancytopenia, pulmonary nodules and ground glass opacities on chest CT, and low-grade disseminated intravascular coagulation. She was treated with broad spectrum anti-microbials without improvement, and when her respiratory status rapidly declined, she was empirically started on steroids and quickly improved. After extensive workup, her overall clinical picture supported the diagnosis of sarcoidosis with pulmonary nodules, alkaline phosphatase elevation, hypercalcemia, elevated angiotensin converting enzyme and soluble IL-2 receptor level, and non-necrotizing granulomas on liver biopsy. Shortly after discharge, polymerase chain reaction of respiratory tract and blood cultures taken during hospitalization resulted positive for mycobacterium avium complex, consistent with disseminated Mycobacterium Avium complex infection mimicking multi-organ system sarcoidosis.

Keywords: Sarcoidosis; Disseminated Mycobacterium Avium complex; Systemic lupus erythematosus; Immunocompromised; Acute respiratory distress

Abbreviations: ACE: Angiotensin Converting Enzyme; ANA: Anti-Nuclear Antibody; BAL: Bronchoalveolar Lavage; CT: Computed Tomography; DIC: Disseminated Intravascular Coagulation; DMAC: Disseminated Mycobacterium Avium Complex; GGOs: Ground Glass Opacities; HLH: Hemophagocytic Lymphohistiocytosis; MLO: Mycoplasma–Like Organism; SLE: Systemic Lupus Erythematosus; PCR: Polymerase Chain Reaction