Sarcoidosis presenting as massive splenomegaly and severe epistaxis, case report

Sarcoidosis is a multisystem disorder of unknown etiology. Extrapulmonary sarcoidosis can involve any organ, but isolated spleen involvement is rare. Diagnosis can be challenging as other etiologies may have similar presentations. A 58-year-old African American female presented with life threatening epistaxis, anemia, refractory thrombocytopenia, and massive splenomegaly. Lymphoproliferative, infectious, and autoimmune etiologies were eliminated with laboratory testing and bone marrow biopsy. The patient had multiple splenic artery aneurysms precluding an open diagnostic splenectomy. Partial splenic artery embolization was performed, which normalized the platelet count and resolved the spontaneous bleeding. This allowed diagnostic splenectomy and splenic artery repair to be safely performed. Surgical pathology demonstrated extensive non-caseating granulomas consistent with sarcoidosis. We present this case to demonstrate the omnipotent nature of sarcoidosis and a complex multi-disciplinary approach for successful diagnosis and treatment. •Sarcoidosis rarely presents with extrapulmonary involvement leading to life-threatening clinical scenarios.•Splenic sarcoidosis as a source of life-threatening platelet sequestration.•Splenectomy can be used as diagnostic and therapeutic intervention in sarcoidosis.•Partial splenic artery embolization provides safe alternative to open splenic artery aneurysm repair.