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We present a unique case of a 46-year-old man who presented with a persistently discharging suprasternal sinus, breathlessness and cough. He is an ex-smoker of 20 pack years, had daily asbestos exposure for 13 years (cutting asbestos sheets) and worked as a dental technician for 10 years. The Mantoux test was strongly positive (previous BCG), and ANCA and calcium were elevated. Chest imaging showed diffuse mediastinal lymphadenopathy, upper lobe pulmonary fibrosis, subpleural nodularity and a reticulonodular coarse infiltrate with beading of the bronchovascular bundles, highly suspicious of sarcoidosis. Pulmonary function testing showed near normal spirometry with a slightly reduced transfer factor.
Lung and mediastinal lymph node biopsies showed …
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