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Laboratory tests revealed pancytopenia (lymphocyte 490 μL, hemoglobin 10.7 g/dL, platelets 110,000 μL) with no hepatic or coagulation abnormalities. The patient presented an increased erythrocyte sedimentation rate (64 mm/h), hypergammaglobulinemia with a monoclonal IgM λ peak (normal renal function, calcium and bone survey), a B2-microglobulin level of 4.14 mg/L, a normal lactate dehydrogenase level and an angiotensin-converting enzyme level >120 U/L. There were no relevant findings in the chest radiography. The abdominal ultrasound revealed splenomegaly of 20 cm, with no signs of liver disease or portal hypertension. The electromyograph revealed axonal sensory-motor neuropathy in both legs. The ophthalmologic examination revealed no abnormalities.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study was completed with an interferon gamma release assay and serology (human immunodeficiency virus, hepatitis B virus, hepatitis C virus, Lues maligna, <span class="elsevierStyleItalic">Leishmania</span>, <span class="elsevierStyleItalic">Toxoplasma</span>, Epstein-Barr virus, human herpes virus 8, <span class="elsevierStyleItalic">Coxiella</span>, <span class="elsevierStyleItalic">Bartonella</span> and <span class="elsevierStyleItalic">Brucella</span>), the results of which were negative. Cytomegalovirus IgG antibodies were not present in the blood polymerase chain reaction. An autoimmune study and biopsy of subcutaneous fat resulted in no relevant findings. A body computed tomography showed massive splenomegaly and supradiaphragmatic and infradiaphragmatic adenopathies suggestive of lymphoproliferative syndrome. Positron emission tomography-computed tomography (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) confirmed the presence of massive splenomegaly and multiple hypermetabolic adenopathies, more noticeable in the bilateral lateral cervical and left axillary lymph nodes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A bone marrow biopsy showed reactive hypercellularity, and histology of one of the lateral cervical adenopathies revealed non-necrotizing granulomas. Given the atypical presentation of the condition and to rule out a splenic lymphoproliferative syndrome, we performed a splenectomy. The presence of a parenchyma completely replaced by non-necrotizing confluent epithelioid granulomas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) confirmed the diagnosis of splenic sarcoidosis.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-14" "fechaAceptado" => "2019-04-23" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Peña Arce C, Vázquez Gómez Ó, Merino Morales F, Diego Hernández C. Sarcoidosis y esplenomegalia masiva: un dilema diagnóstico. Rev Clin Esp. 2020;220:520–521.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 410 "Ancho" => 756 "Tamanyo" => 43699 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 568 "Ancho" => 756 "Tamanyo" => 133687 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000008/v2_202102250825/S2254887419301444/v2_202102250825/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000008/v2_202102250825/S2254887419301444/v2_202102250825/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301444?idApp=WRCEE" ]
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