Advanced Sarcoidosis with Apparent Onset by Respiratory Failure.

We present the case of a 14 years-old male (with poor living condition, non-smoker) hospitalized for a sudden onset of a rest dyspnea, mucopurulent cough. We found bronchial sibilant rales, wheezing, cyanosis, peripheral adenopathies, hepatosplenomegaly, purulent tonsillitis. the chest-x-ray revealed bilateral mediastinal lymphadenopathy and bilateral lung infiltrations. Spirometry: severe mixed ventilator dysfunction without reversibility. Sputum: negative microscopy and culture for Koch bacillus. Stool examination: cysts of Lamblia giardia. The patient refused bronchoscopy and mediastinoscopy, so it was performed axillary lymph node biopsy which confirmed sarcoidosis (non-caseating epithelioid granulomas). The treatment included antibiotics, antiparasites, oral and inhaled corticosteroids (CS), bronchodilators, oxygen, with clinical/functional improvement after 3 months. CS was followed 1.5 years with poor compliance. A relapse occurred after 3 years and the CS were reinserted. The computerized tomography (CT) scan revealed a diffuse interstitial fibrosis with bronchiectasis. The case particularity relies on the atypical early onset of the sarcoidosis, with respiratory failure and progression to lung fibrosis despite CS treatment. The association of proinflammatory risk factors such as multiple infections needs to be noted.