A 45-Year-Old Man With Severe Dysphagia and Pulmonary Infiltrates

(CHEST 2007; 131:1256–1259) A 35-year-old African-American man presented with cough and mild dyspnea on exertion over 3 to 4 years. His sister was known to have sarcoidosis. Physical examination revealed a slight man with mild clubbing. The chest radiograph (Fig 1) and chest CT scan (Fig 2) both demonstrated bilateral diffuse nodular interstitial and alveolar infiltrates, mediastinal and hilar lymphadenopathy, and upper-lobe fibrobullous changes consistent with sarcoidosis. A presumptive diagnosis of sarcoidosis was made; additional evaluation revealed cutaneous anergy, serum angiotensin-converting enzyme level of 108 IU (normal, 8 to 52 IU), chronic uveitis, and marked restriction on pulmonary function testing. No treatment was undertaken at this time. At age 45 years, the patient presented with worsening dysphagia over 1 year, which precluded oral intake. He noted a sensation of food getting stuck in his upper chest and occasional regurgitation, associ