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Nartey M, Ulzen-Appiah K. Exertional Dyspnea Incidentally Diagnosed as Sarcoidosis: A Teaching Hospital Experience. Case Rep Pulmonol 2023; 2023:8689352. [PMID: 37706114 PMCID: PMC10497360 DOI: 10.1155/2023/8689352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/22/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023] Open
Abstract
Background Sarcoidosis is a complex disease with nonspecific etiology and clinical presentation. Its diagnosis is often delayed due to the absence of a single specific investigation modality. A multidisciplinary approach is necessary for its diagnosis. Report. A 49-year-old male presented with recurrent dyspnea on exertion, easy fatigue, and chest pain after several visits to different health facilities over 5 months. A diagnosis of pulmonary sarcoidosis was made after a series of laboratory and imaging investigations were done revealing bilateral reticonodular opacifications, noncaseating granulomata, elevated serum ACE and calcium levels consistent with sarcoidosis. Conclusion Sarcoidosis, although a rare presentation in our setting, may easily be overlooked or misdiagnosed if a holistic or multidisciplinary approach is not employed in its diagnosis. Nonspecificity of symptoms contributes to the delayed diagnosis.
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Affiliation(s)
- Melvina Nartey
- Department of Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Kofi Ulzen-Appiah
- Department of Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast Teaching Hospital, Cape Coast, Ghana
- ACT Pathology Consult, Cape Coast, Ghana
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Valdoleiros SR, Calejo M, Marinho A, Martins da Silva A, Vasconcelos O, Gonçalves MJ, Sarmento E Castro R. First report of concomitant cryptococcal meningitis and anti-NMDAR encephalitis. Brain Behav Immun Health 2020; 2:100036. [PMID: 34589827 PMCID: PMC8474238 DOI: 10.1016/j.bbih.2020.100036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder, seen most often in young adults and children, triggered by tumors or infections. We report a case of cryptococcal meningitis in a patient with sarcoidosis, presenting prominent neuropsychiatric symptoms, electroencephalographic features of autoimmune encephalitis and positive anti-NMDAR antibodies in the cerebrospinal fluid, raising the hypothesis of an infectious immune-mediated mechanism triggering the production of anti-NMDAR antibodies. Since anti-NMDAR encephalitis is potentially fatal and has significant morbidity, further descriptions of its etiological associations are essential to early identification and prompt treatment. Cryptococcal meningitis is a rare complication of sarcoidosis and CD4 lymphopenia. Anti-NMDAR encephalitis is an autoimmune disorder triggered by tumors or infection. A case of concomitant cryptococcosis and anti-NMDAR encephalitis is presented.
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Affiliation(s)
- Sofia R Valdoleiros
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Margarida Calejo
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - António Marinho
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4099-001, Porto, Portugal
| | - Ana Martins da Silva
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4099-001, Porto, Portugal
| | - Olga Vasconcelos
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Maria João Gonçalves
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Rui Sarmento E Castro
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
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Duréault A, Chapelon C, Biard L, Domont F, Savey L, Bodaghi B, Pourcher V, Rigon MR, Cacoub P, Saadoun D. Severe infections in sarcoidosis: Incidence, predictors and long-term outcome in a cohort of 585 patients. Medicine (Baltimore) 2017; 96:e8846. [PMID: 29245251 PMCID: PMC5728866 DOI: 10.1097/md.0000000000008846] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 12/20/2022] Open
Abstract
Sarcoidosis is associated with cell-mediated immunodeficiency and treatment of symptomatic sarcoidosis usually includes systemic immunosuppressants. Data relative to incidence, prognosis factors, and outcome of infections are scarce.Retrospective cohort study of 585 patients with biopsy proven sarcoidosis in a tertiary referral specialist clinic, with a nested case-control analysis. Twenty nine patients (4.9%) with severe infections were compared to 116 controls subjects with sarcoidosis, matched according to their gender, ethnicity, age at diagnosis, and treatment with corticosteroids.After a median follow-up of 8 years [range; 1-46], 38 severe infections [mycobacterial infections (n = 14), fungal infections (n = 10), bacterial (n = 8), viral (n = 3) and parasitic (n = 1)] were observed in 30 patients. The incidence of severe infections was 0.71% persons-year (CI 95% 0.5-0.98) and 0.43% persons-year (CI 95% 0.27-0.66). Patients with severe infection were more frequently of male gender (60% vs 46%) and were more likely treated by ≥ 3 immunosuppressive agents (OR = 3.8, IC 95% [1.5-9.64], P = .005) and by cyclophosphamide (OR = 5.55, IC 95% [1.9-16.1], P = .002), and with neurological (OR = 3.36 CI 95% [1.37-8.25], P = .008), or cardiac (OR = 2.65 CI 95% [1.09-6.43], P = .031) involvement of the sarcoidosis, compared to the controls. Two patients died within the 6 months following infection, due to progressive multifocal leucoencephalopathy (n = 1), and of peritonitis (n = 1).Severe infections are observed in 5.1% of our patients with sarcoidosis after a median follow-up of 8 years. Risk factors for severe infections included neurological or cardiac involvement of sarcoidosis, the use of immunosuppressive agents and mainly cyclophosphamide.
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Affiliation(s)
- Amélie Duréault
- Département de Médecine Interne et d’Immunologie Clinique, Hôpital Pitié Salpétrière, Paris, France. Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Université Pierre et Marie Curie, Paris, France. DHU Inflammation, Immunopathology, Biotherapy UPMC, Paris VI
| | - Catherine Chapelon
- Département de Médecine Interne et d’Immunologie Clinique, Hôpital Pitié Salpétrière, Paris, France. Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Université Pierre et Marie Curie, Paris, France. DHU Inflammation, Immunopathology, Biotherapy UPMC, Paris VI
| | - Lucie Biard
- Department of Biostatistics and Medical Information (SBIM)
| | - Fanny Domont
- Département de Médecine Interne et d’Immunologie Clinique, Hôpital Pitié Salpétrière, Paris, France. Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Université Pierre et Marie Curie, Paris, France. DHU Inflammation, Immunopathology, Biotherapy UPMC, Paris VI
| | - Léa Savey
- Département de Médecine Interne et d’Immunologie Clinique, Hôpital Pitié Salpétrière, Paris, France. Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Université Pierre et Marie Curie, Paris, France. DHU Inflammation, Immunopathology, Biotherapy UPMC, Paris VI
| | - Bahram Bodaghi
- Department of Ophtalmology, Université Pierre et Marie Curie
| | - Valérie Pourcher
- Department of Infectious disease, Hôpital Pitié Salpétrière, Paris, France
| | | | - Patrice Cacoub
- Département de Médecine Interne et d’Immunologie Clinique, Hôpital Pitié Salpétrière, Paris, France. Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Université Pierre et Marie Curie, Paris, France. DHU Inflammation, Immunopathology, Biotherapy UPMC, Paris VI
| | - David Saadoun
- Département de Médecine Interne et d’Immunologie Clinique, Hôpital Pitié Salpétrière, Paris, France. Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Université Pierre et Marie Curie, Paris, France. DHU Inflammation, Immunopathology, Biotherapy UPMC, Paris VI
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Occam's razor or Hickam's dictum? J Bronchology Interv Pulmonol 2013. [PMID: 23207465 DOI: 10.1097/lbr.0b013e31825c6d0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sarcoidosis is a multisystemic, inflammatory disorder characterized by non-necrotizing granulomas that can infiltrate almost any organ but involves the lungs most commonly. The exact pathogenesis of sarcoidosis remains unclear. Histoplasmosis is an infection caused by Histoplasma capsulatum that also predominantly affects the lungs and is characterized usually by necrotizing granulomas. The similar clinical features of sarcoidosis and histoplasmosis often make it difficult to distinguish these 2 processes. We report a young man who had histopathologic evidence of histoplasmosis and subsequently developed sarcoidosis. The similar clinical and radiographic manifestations of sarcoidosis and histoplasmosis and a possible role of histoplasmosis as an etiologic agent for sarcoidosis are discussed.
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Bernard C, Maucort-Boulch D, Varron L, Charlier C, Sitbon K, Freymond N, Bouhour D, Hot A, Masquelet AC, Valeyre D, Costedoat-Chalumeau N, Etienne M, Gueit I, Jouneau S, Delaval P, Mouthon L, Pouget J, Serratrice J, Brion JP, Vaylet F, Bremont C, Chennebault JM, Jaffuel S, Broussolle C, Lortholary O, Sève P. Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases. QJM 2013; 106:523-39. [PMID: 23515400 DOI: 10.1093/qjmed/hct052] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM To describe the main characteristics and the treatment of cryptococcosis in patients with sarcoidosis. DESIGN Multicenter study including all patients notified at the French National Reference Center for Invasive Mycoses and Antifungals. METHODS Retrospective chart review. Each case was compared with two controls without opportunistic infections. RESULTS Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients. CONCLUSIONS Cryptococcosis is a significant opportunistic infection during extra-thoracic sarcoidosis, which occurs in one-third of the cases in patients without any treatment; it is not associated to severe CD4 lymphocytopenia and has a good prognosis.
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Affiliation(s)
- C Bernard
- Department of Internal Medicine, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
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Pallin M, O'Sullivan C, Dodd JD, McCreery K, Brett F, Farrell M, O'Brien D, Hall WW, Tubridy NJ, Keane MP. A case of progressive multifocal leukoencephalopathy in a patient with sarcoidosis. QJM 2012; 105:1011-6. [PMID: 21893584 DOI: 10.1093/qjmed/hcr154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Pallin
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Charlier-Woerther C, Fenoll C, Bouges-Michel C, Valeyre D, Lortholary O, Masquelet AC. Cryptococcal myositis and sarcoidosis. Med Mal Infect 2011; 41:268-70. [DOI: 10.1016/j.medmal.2010.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 04/02/2010] [Accepted: 12/27/2010] [Indexed: 11/15/2022]
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Infliximab et sarcoïdose chronique. L’expérience française à propos de 31 cas. Rev Mal Respir 2010; 27:685-92. [DOI: 10.1016/j.rmr.2010.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Accepted: 12/13/2009] [Indexed: 12/28/2022]
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Current World Literature. Curr Opin Rheumatol 2010; 22:97-105. [DOI: 10.1097/bor.0b013e328334b3e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mouthon L, Salmon D. Risque infectieux et maladies systémiques : où en sommes nous en 2009 ? Presse Med 2009; 38:232-4. [DOI: 10.1016/j.lpm.2008.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 11/26/2022] Open
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