• Hiroyuki Higuchi, Shinichi Okuzumi, Tomoo Kakimoto, Kenta Hamabe, Shojiroh Morinaga, and Naoto Minematsu.
• Department of Medicine, Hino Municipal Hospital, Japan.
• Intern. Med. 2023 Aug 15; 62 (16): 239524002395-2400.

AbstractPulmonary sarcoidosis may occasionally present with large bullae, but the clinical implications of this finding remain unclear. We herein report the complete clinical course of a case of pulmonary bullous sarcoidosis. Chest computed tomography initially showed subpleural and peribronchovascular lung opacities, and bullae spontaneously developed in adjacent less-affected regions, probably via a retraction mechanism. Bullae progression was refractory to corticosteroid treatment and associated with deterioration of respiratory symptoms. The later phase involved repeated bacterial and fungal infections of the bullous lungs, eventually causing respiratory failure and mortality. Postmortem examinations revealed aggressive pulmonary Mycobacterium avium infection and diffuse alveolar damage.

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