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Jung, Moon, Yoon, Byun, Jung, Jung, Choi, Kim, Pyo, Kim, Kim, Chang, Kim, and Park: A Case of Successful Management of Sarcoidosis with Chylothorax Using Octreotide
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 62(2): 119-124.

Published online: 28 February 2007

DOI: https://doi.org/10.4046/trd.2007.62.2.119

A Case of Successful Management of Sarcoidosis with Chylothorax Using Octreotide

Kyung Soo Jung, M.D.1, Ji Ae Moon, M.D.1, Sul hee Yoon, M.D.1, Min Kwang Byun, M.D.1, Woo Young Jung, M.D.1, Jae Hee Jung, M.D.1, Sang Bong Choi, M.D.1, Dae Joon Kim, M.D.2, Ju Yeon Pyo, M.D.3, Young Sam Kim, M.D.1, 4, Se Kyu Kim, M.D.1, 4, Joon Chang, M.D.1, 4, Sung Kyu Kim, M.D.1, 4, Moo Suk Park, M.D.1, 4

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2Department of Cardiovascular & Thoracic Surgery, Yonsei University College of Medicine, Seoul, Korea.

3Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

4The 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

Received 29 November 2006       Accepted 2 January 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

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.

Keywords: Sarcoidosis, Chylothorax, Pleural involvement, Octreotide, Mediastinoscopy

Figures and Tables

Figure 1
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.
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Figure 2
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.
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Figure 3
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)
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