Atraumatic forearm swelling in a patient with poorly controlled asthma

Matthew Leon; Robert Liotta; Shambhu Aryal; Peter Vangeertruyden; Scott Tintle; Mary Klassen-Fischer; Aaron Holley; William Kelly; Jacob Collen

doi:10.1016/j.rmcr.2021.101454

Atraumatic forearm swelling in a patient with poorly controlled asthma

Respir Med Case Rep. 2021 Jul 1:33:101454. doi: 10.1016/j.rmcr.2021.101454. eCollection 2021.

Authors

Matthew Leon¹, Robert Liotta², Shambhu Aryal³, Peter Vangeertruyden⁴, Scott Tintle⁵, Mary Klassen-Fischer⁶, Aaron Holley^{7

8}, William Kelly^{7

8}, Jacob Collen^{7

8}

Affiliations

¹ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
² Thoracic Radiology, Uniformed Services of the Health Sciences, Bethesda, MD, USA.
³ Advanced Lung Disease Program, Inova Fairfax Hospital, Falls Church, VA, USA.
⁴ Musculoskeletal Radiology, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA.
⁵ Hand Surgery, Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁶ Thoracic Pathology, Joint Pathology Center, Silver Spring, MD, USA.
⁷ Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁸ Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Abstract

We present a case of sarcoidosis presenting as unilateral forearm swelling. A 65-year-old male with a long history of asthma presented with unexplained left forearm and hand swelling. Over many years, chest imaging had been devoid of adenopathy or parenchymal findings suspicious for sarcoid, until after the extremity findings emerged. The patient was diagnosed based on subcutaneous, dermal and mediastinal lymph node histopathology. Sarcoid presenting with isolated extremity findings prior to more typical pulmonary manifestations is rare even for cutaneous or soft tissue sarcoid, highlighting the need to maintain a high index of suspicion for sarcoidosis.

Keywords: Asthma; BAL, bronchoalveolar lavage; Bronchiectasis; CT, computed tomography; Darier-Roussy disease; ED, emergency department; Extrapulmonary; Granulomatous disease; Sarcoidosis; Subcutaneous; TBBX, transbronchial biopsy.

Publication types

Case Reports