Sarcoidosis with Splenic Involvement: Two Case Reports from a Single Centre from Northern Sri Lanka

Splenic sarcoidosis is a rare clinical entity which can have heterogeneous clinical presentation. We highlight two different clinical encounters of splenic sarcoidosis with coexistent pulmonary sarcoidosis, which needs high degree of clinical suspicion to diagnose in complexed burnt out state and importance of timely diagnosis and early initiation of corticosteroids to minimize disease progression. Case 1; 58 year old previously healthy female presented with marked constitutional symptoms and left side upper abdominal discomfort over 6 months period with unremarkable clinical examination on admission. Her chest X ray on admission simulated the appearance of lymphangitic carcinomatosis, however ultrasound guided splenic tru-cut biopsy confirmed the diagnosis of splenic sarcoidosis and patient responded to corticosteroid therapy. Case 2; 21 year old young male was evaluated for pyrexia of unknown origin for three months. His clinical examination was only significant for bilateral cervical discrete lymph node enlargement and chest X ray on admission showed bilateral hilar enlargement and initial ultrasound abdomen revealed multiple hypoechoiec splenic lesions. Finally brochoscopy guided lung biopsy confirmed the diagnosis and patient was remarkably improved with corticosteroid treatment. Splenic sarcoidosis has heterogeneous clinical presentation. Judicial use of imaging, appropriate tissue biopsy together with correct clinical judgment will enable early diagnosis and early treatment with corticosteroid will have favorable patient outcome.