It’s All in the History

Sarcoidosis can affect multiple systems in the body especially the lungs and the skin. In our case, we highlightan extrapulmonary case of sarcoidosis masquerading as lung & testicular mass in a 30-year-old African-American male.Hospital Course: An African American male without previous medical history presented with coughing and testicularswelling for over 1 month. The patient had adrastic weight loss, exertional dyspnea, and bilateral testicular swelling.Smoked daily one-fourthpack-per-day. On physical exam, patient had clear auscultation of the chest bilaterally and largeleft testicular mass measuring at least 6 cm. Laboratory tests show relatively unremarkable CBC and CMP. LDH was high at238. Computed tomography of the chest/abd/pelvis without contrast showed innumerable pulmonary nodules in the bilaterallungs. Ultrasound of testicles found numerous bilateral hypoechoic testicular lesions. A right upper lung endobronchialbiopsy revealed granulomatous inflammation without malignant cells related to pulmonary sarcoidosis with testicularinvolvement. ACE send-out was high at 138 U/L. Patient was started on steroids with 10 mg daily and doxycycline 100 mgtwice daily for seven days.Discussion: The “great mimicker” is a well-deserved moniker for sarcoidosis because of its multisystem involvement andbroad symptomology it can be a challenging diagnosis. In order to diagnose sarcoidosis, a thorough history and physicalexam are required. The genitourinary presentations of sarcoidosis are extremely rare. Extrapulmonary sarcoidosis canregress spontaneously or it can progress in select patients to malignancy which requires tailored treatment with eithercorticosteroids or orchiectomy.