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In 1996, a 51-year-old woman was diagnosed as having sarcoidosis of the ethmoid sinuses with lacrimal duct involvement (bilateral hilar prominence on chest radiograph). She underwent endoscopic ethmoidectomy (histopathological evaluation of the tissue confirmed sarcoidosis) followed by a short course of systemic corticosteroids and nasal steroids with complete resolution of symptoms.
She presented again in 2005 with shortness of breath on exertion. High-resolution computed tomography of the thorax showed bilateral parenchymal changes with hilar lymphadenopathy. However, she refused to be treated with corticosteroids. Subsequently, she developed severe inflammatory low backache along with bilateral shoulder pains for which she received diclofenac. As there was no improvement in the …
Competing interests: None.
Patient consent: Obtained.
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