SHM Converge Scientific Abstract ePoster Gallery-There Is More to Sarcoidosis Than Meets the Lungs: A Case of Heerfordt-Waldenstrom Syndrome

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A 36-year-old man with no significant past medical history presented with progressive bilateral facial swelling, later accompanied by fevers, night sweats, 12-pound weight loss, dyspnea on exertion, and forehead tingling. Exam showed bilateral non-tender facial swelling and an asymmetric smile, while lung exam and ophthalmologic evaluation were unremarkable. Labs revealed leukopenia and elevated liver enzymes.<br /><br />Imaging and cardiac workup demonstrated findings concerning for systemic sarcoidosis: chest X-ray showed bilateral hilar adenopathy and diffuse interstitial prominence; chest CT revealed extensive mediastinal and hilar lymphadenopathy, pulmonary interstitial thickening/reticulation, and innumerable ground-glass nodules. ECG showed normal sinus rhythm with left ventricular hypertrophy, and cardiac MRI showed mid-myocardial delayed enhancement in the inferior apical wall.<br /><br />Bronchoscopy with lymph node biopsy confirmed granulomas composed of spindled to epithelioid histiocytes, consistent with sarcoidosis. The patient was started on prednisone 1 mg/kg daily and experienced significant symptom improvement.<br /><br />This case highlights sarcoidosis as a granulomatous disease with varied pulmonary and extrapulmonary manifestations. Although it most commonly presents with pulmonary symptoms and is more frequent in African Americans, females, and adults aged 20–39, clinicians should recognize rarer forms such as Heerfordt-Waldenström syndrome. Characteristic features include parotid gland enlargement, facial palsy, anterior uveitis, and fever. Diagnosis relies on compatible clinical and radiologic findings supported by histologic evidence of noncaseating granulomas.

Asset Subtitle

Daniel W. Shields Jr.

Meta Tag

Author List Daniel W. Shields Jr., Emma Neahusan, Michael Dore

Category Clinical Vignettes

Concept Sarcoidosis

Concept Noncaseating Granuloma

Concept Heerfordt-Waldenström Syndrome

Concept Bilateral Hilar Lymphadenopathy

Concept Granulomatous Disease

Distinguished Non-Finalist

Presenter Organization Naval Medical Center Portsmouth

Presenting Author Daniel W. Shields Jr.

Track Adult

Keywords

sarcoidosis

Heerfordt-Waldenström syndrome

bilateral facial swelling

noncaseating granulomas

hilar adenopathy

mediastinal lymphadenopathy

pulmonary interstitial thickening

cardiac MRI delayed enhancement

facial palsy

prednisone treatment

Sarcoidosis

Noncaseating Granuloma

Heerfordt-Waldenström Syndrome

Bilateral Hilar Lymphadenopathy

Granulomatous Disease