Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 2005-6184 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2007.62.2.119 Case Report A Case of Successful Management of Sarcoidosis with Chylothorax Using Octreotide Jung Kyung Soo M.D. 1 Moon Ji Ae M.D. 1 Yoon Sul hee M.D. 1 Byun Min Kwang M.D. 1 Jung Woo Young M.D. 1 Jung Jae Hee M.D. 1 Choi Sang Bong M.D. 1 Kim Dae Joon M.D. 2 Pyo Ju Yeon M.D. 3 Kim Young Sam M.D. 1 4 Kim Se Kyu M.D. 1 4 Chang Joon M.D. 1 4 Kim Sung Kyu M.D. 1 4 Park Moo Suk M.D. 1 4 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. Department of Cardiovascular & Thoracic Surgery, Yonsei University College of Medicine, Seoul, Korea. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea. The Institute of Chest Diseases, Seoul, Korea. Address for correspondence: Moo Suk Park, M.D. Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 134 Shinchon-dong Seodaemun-gu, 120-752, Seoul, Korea. Phone: 02-2228-1974, Fax: 02-393-6884, pms70@yumc.yonsei.ac.kr 02 2007 28 02 2007 62 2 119 124 29 11 2006 02 01 2007 Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases 2007

Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea.

Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed.

We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid.

We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid.

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A) High resolution computed tomography (HRCT) scan taken before mediatinoscopic biopsy, showed multiple enlarged or non enlarged and conglomerated lymph nodes at both hilum and mediastinum. B) HRCT scan taken after octreotide and prednisolone treatment of 3 weeks, showed a complete resolution of right pleural effusion and a decrease of multiple lymphadenopathy at both hila and mediastinum.

A) Chest X-ray taken after mediastinoscopic biopsy of 1 month, showed a right pleural effusion. B) Chest X-ray taken after octreotide and prednisolone treatment of 3 weeks, showed a complete resolution of right pleural effusion.

Microscopic examination of samples by mediastinoscopic biopsy showed chronic granulomatous inflammations without caseous necrosis which consistent with sarcoidosis (A: H & E, ×40, B; H & E, ×200)