Necrotizing Sarcoid Granulomatosis in a 15-Year-Old Male

BACKGROUND: Necrotizing sarcoid granulomatosis is a rare disease in adults but it is even rarer in the pediatric population. With only a few case reports available in the literature, physicians still do not have clear cut guidelines on how to approach a child with this disease entity. There is an ongoing debate as to whether necrotizing sarcoid granulomatosis is a variant of sarcoidosis or a separate disease. Necrotizing sarcoid granulomatosis is mainly diagnosed based on radiological findings of pulmonary nodular infiltrates and characteristic pathological changes, such as non-caseating epithelioid cell granulomas, granulomatous vasculitis, and necrosis.
CASE REPORT: We present the case of a 15-year-old African-American male who developed abdominal pain, weight loss, fever, cough, and night sweats over the course of 7 weeks. The patient was ultimately diagnosed with necrotizing sarcoid granulomatosis based on the pathology findings in a thoracoscopically-obtained pleural biopsy. He improved after initiating treatment with oral prednisolone.
CONCLUSIONS: Through this case report, we hope to add insight regarding necrotizing sarcoid granulomatosis in the pediatric population and to encourage physicians to consider necrotizing sarcoid granulomatosis (whether considered a variant of sarcoidosis or a separate disease entity) as a possible differential diagnosis in similar clinical presentations once infectious and autoimmune etiologies have been ruled out.

Keywords: Mycobacterium avium Complex, Pediatrics, sarcoidosis