Clinical Image - International Journal of Clinical & Medical Images (2015) Volume 2, Issue 2
Author(s): Andreani A* and Cappiello G
A 35-year-old ex-smoker varnisher man presented at our attention for a few days history of left thoracic pain, low-grade fever, asthenia, swelling of both parotid glands and dry eyes. Once excluded cardiac diseases, we performed physical examination which only revealed enlargement of both parotid glands (this was also confirmed from ultrasonography of the parotid glands; (Figure 1) and bloodshot eyes (with uveitis, as stated by the Ophthalmologist). The chest radiograph (Figure 2) showed the presence of bilateral hilar lyphoadenopathy. We so performed computed tomography of the thorax which confirmed the presence of lymphoadenopathy in paratracheal, subcarinal and hylar station associated with bilateral interstitial tickening of lung parenchyma (Figure 3).
We performed bronchoscopy with transbronchial needle aspiration (TBNA) (using a histologic 19 G needle) in subcarinal station (station number 7 according to IASCL lymph node map) and in right interlobar station (station R11).
Pathological tissue demostrated the presence of non-caseating granulomas without necrosis (Figure 4). He was given a diagnosis of Heerfordt’s syndrome, a rare form of sarcoidosis (present only in 6% of the cases of sarcoidosis) charactherized by the presence of enlargement of the parotid gland associated with major symptoms as uveitis, facial paralysis (absent in our case) or fever [1,2]. He was started on 50 mg of prednisone daily, and at follow-up 15 days later, he was completely asymphtomatic (and the swelling and bloodshot eyes resolved).