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A 47-year-old female visited an ophthalmologist complaining of reduced visual acuity and eye congestion in September 1997. The ophthalmologist diagnosed her as anterior and posterior uveitis from ocular findings such as trabecular nodules, iris nodules, vitreous opacities, and retinal perivasculitis. Suspecting sarcoidosis he referred her to the Department of Respiratory Diseases of Sapporo Hospital of Hokkaido Railway Company in February 1998. A chest radiograph showed normal. Several examinations such as PPD skin test, Gallium citrate scintigraphy, findings from bronchoalveolar lavage and serum angiotensin converting enzyme assay, serum lysozyme, and gamma-globulin didn't offer evidence that she had systemic sarcoidosis. Transbronchial lung biopsy specimens from 10 lung sites also failed to detect noncaseating epithelioid cell granuloma. Eight years later, she came to my clinic due to abnormal findings on chest radiograph taken as part of the normal mass health check. Her ocular involvement was unchanged. She showed mediastinal lymphadenopathy on chest radiograph. Chest computed tomography showed slight mediastinal and bilateral hilar lymphadenopathy. Clinical examinations showed an elevated level of serum angiotensin converting enzyme: 25.5 U/L (normal 7.0-25.0 U/L). Findings of bronchoalveolar lavage showed 4% for lymphocyte rate and 1.9 for CD4/CD8 ratio. Transbronchial lung biopsy specimens revealed noncaseating epithelioid cell granuloma, so she was diagnosed as having systemic sarcoidosis.
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