A patient who abuses cocaine may present with all of the features of pulmonary sarcoidosis.


Clinical findings:

(1) dyspnea

(2) abnormal pulmonary function tests

(3) history of cocaine abuse, typically crack cocaine

(4) reversal or improvement on discontinuation of cocaine abuse


Radiographic findings:

(1) bilateral, diffuse interstitial pulmonary infiltrates

(2) bilateral hilar lymphadenopathy


Biopsy findings:

(1) noncaseating granulomas in lung and lymph nodes

(2) negative stains for acid fast bacilli and fungi

(3) The granulomas may show polarizable material.


Laboratory findings:

(1) elevated serum angiotensin converting enzyme (ACE; an elevation may occur in any granulomatous disorder)

(2) cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) may be positive

(3) cultures for mycobacteria and fungi are negative


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