Strange case – thoughts?

Hello,

We have a strange case of lung, bone and nodal lesions which are behaving
quite aggressively. The patient has had 4 biopsies all of which have come
back with non-necrotizing granulomas. The working diagnosis is
sarcoidosis, but there remains a concern that we may not have it right.
Has anyone seen sarcoid (or something else) behave like this with such a
result from biopsies? To date, all micro has been negative.

Thanks for your thoughts!

Adam

case_ocad.pdf