Progressive Chronic Sarcoidosis: a Report of Multiorgan Involvement in a Young Woman and a Literature Review

Abstract

Sarcoidosis is a systemic inflammatory disease of unknown etiology that can involve multiple organs, with variable clinical presentations ranging from self-limited to chronic, progressive forms. While pulmonary involvement is the most common, extrapulmonary manifestations can occur, and multi-organ involvement is rare. We present the case of a 26-year-old woman with chronic sarcoidosis who exhibited progressive involvement of the kidneys, lungs, extrathoracic adenopathy, bone marrow, spleen, heart, and possibly the gallbladder. This patient’s clinical course began with nonspecific symptoms such as fever, dysuria, and abdominal pain, and progressively worsened over time. The diagnosis of sarcoidosis was established after ruling out other potential causes through comprehensive laboratory studies, imaging, and biopsy findings. Despite the absence of definitive markers, elevated serum angiotensin-converting enzyme and histological analysis of granulomas in the bone marrow contributed to the diagnosis. The patient’s management involved a combination of corticosteroids and mycophenolate mofetil, resulting in significant clinical improvement. Surgical interventions, including splenectomy and lithotripsy, were also required. The patient showed recovery in the long-term, with resolution of pulmonary and systemic symptoms. This case highlights the unpredictable and progressive nature of chronic sarcoidosis with multi-organ involvement and underscores the importance of early diagnosis and comprehensive management. It also emphasizes the rarity of such widespread organ involvement and the need for a multidisciplinary approach to treatment, including pharmacological and surgical interventions, to manage complex cases of sarcoidosis.