A 37-year-old Caucasian woman, with no medical history of interest was seen at the clinic. She had presented epigastric and left hypochondrial mild, intermittent pain for years, with a daily frequency and with no relation to meals, having no other associated systemic symptoms. Physical examination was normal. Laboratory studies showed normal acute phase reactants, peripheral blood smear and angiotensin converting enzyme, as well as proteins and autoimmunity, infectious disease (including hydatidosis) and a Mantoux test. Chest and abdomen test, gastrointestinal transit images and electrocardiogram were all normal. An abdominal ultrasound and thoracoabdominal computed tomography showed multiple splenic lesions measuring 7–9mm in diameter, with no spleen enlargement (Fig. 1). The abdominal magnetic resonance showed multiple lesions on the spleen, hypointense in T2 and isointense in T1, with homogeneous and late enhancement upon contrast, with a diameter under 1cm (Fig. 2). Due to the persistence of left hypochondrial pain as well as the diagnostic uncertainty, a laparoscopic splenectomy was programmed. Macroscopically, the spleen presented multiple external and intraparenchymal nodules of a white-fibrous aspect and with a diameter under 1cm; microbiological tests were negative and the lesions were histologically compatible with non-casefying epithelioid granulomas (Fig. 3). After the uncomplicated splenectomy, the patient remained asymptomatic and with no treatment during follow-up.

Fig. 1.

Abdominal contrast CT scan, which shows multiple spleen lesions with no contrast uptake (arrows).

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Fig. 2.

Abdominal MIR with gadolinium center in T2 showing splenic lesions (arrows).

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Fig. 3.

Microscopic histology of the spleen with non-casefying granulomas (arrows).

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Sarcoidosis is a granulomatous multisystemic disease of unknown etiology.1 More than 90% of affected patients have pulmonary manifestations at the moment of diagnosis.2 The extrapulmonary multiorganic affection is frequent, with the spleen involved in 10% in imaging studies and up to 40% in autopsies,3 being asymptomatic only in 5%–7%.4 However, because the affection is exclusively splenic, as was seen in our patient, it is extraordinarily infrequent, and we consider it relevant to present because the correlation between clinical, imaging and histological testing has been seldom reported in previous case publications.5,6