[Pleural sarcoidosis: report of cases and review of the literature].

OBJECTIVE: To analyze the clinical features and differential diagnosis of pleural disease caused by sarcoidosis. METHODS: The clinical data of cases of sarcoidosis diagnosed with pathological evidence in this hospital were retrospectively analyzed. The clinical features and the diagnostic procedures of the cases with pleural disease as the main manifestations were reported. A review of case reports and series published in Chinese literature were carried out to study the incidence and the features of pleural effusion and pneumothorax in sarcoidosis. RESULTS: Thirty-two cases of pulmonary sarcoidosis were diagnosed with pathological evidence, of which 2 cases (2/32, 6.3%) presented as pleural effusion with one confirmed by medical thoracoscopy; one case (1/32, 3.1%) presented as recurrent pneumothorax and interstitial lung disease, and the diagnosis was confirmed by open lung biopsy. Pleural fluid analysis showed exudates with lymphocyte predominance. The fluid level of adenosine deaminase (ADA) was all less than 30 U/L and increased angiotensin converting enzyme level was demonstrated in one case. All 3 cases had been misdiagnosed as tuberculosis and received anti-tuberculous therapy for a period of 1 - 12 months. A review of the case reports and series in Chinese literature showed that the incidence of pleural disease in sarcoidosis was 3.4% - 16.7% in different series, and that pleural effusion in sarcoidosis was misdiagnosed as tuberculous in most cases. CONCLUSIONS: Pleural sarcoidosis is not rare in Chinese patients, but often misdiagnosed as tuberculous pleural disease. Recognition of this fact is of clinical importance both in the diagnosis of sarcoidosis and in the differential diagnosis of pleural diseases.