1
|
Fatih MT, Saleh RS, Majeed TF, Mahmood MK. Lack of pulmonary involvement leads to a 3 years delay of diagnosis in a childhood sarcoidosis case with arthritis, ocular symptoms, and bilateral parotid swelling. Clin Case Rep 2024; 12:e8982. [PMID: 38845801 PMCID: PMC11154798 DOI: 10.1002/ccr3.8982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/16/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
Key Clinical Message This paper presents a rare sarcoidosis case in a child of 12 years of age presented with arthritis, bilateral parotid enlargement and ocular, but unfortunately the diagnosis has been missed due to lack of pulmonary involvement. Abstract Diagnosis of sarcoidosis is by exclusion, and sometimes, it can be challenging. This paper presents a rare sarcoidosis case in a child of 12 years of age presented with bilateral parotid enlargement. The signs of musculoskeletal and ocular involvement were present before the parotid enlargement, and the parotid swelling persisted for 3 years; but unfortunately the definite diagnosis has been missed by the previous healthcare professionals most probably due to the rarity of the situation, especially lack of pulmonary involvement. Therefore, cooperation between different healthcare specialties is important for an effective diagnosis and management. Despite its rarity, sarcoidosis should always be present in the list of differential diagnosis when encountering multisystem entities like arthritis, ocular symptoms and parotid swelling.
Collapse
Affiliation(s)
| | - Renaz Sabir Saleh
- Dentistry DepartmentKomar University of Science and TechnologyKurdistanIraq
| | | | | |
Collapse
|
2
|
Hangül M, Köse M, Pekcan S, Ersoy A, Unal G, Caglar HT. Childhood sarcoidosis in the middle Anatolia of Turkey. Pediatr Pulmonol 2023; 58:2619-2627. [PMID: 37341617 DOI: 10.1002/ppul.26564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/26/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE This retrospective study aimed to describe the clinical and radiological features, diagnostic methods, laboratory findings, organ involvement, and treatment strategies of 22 patients who followed up with late-onset childhood sarcoidosis and compare them with the literature. MATERIAL AND METHOD This retrospective multicenter study reviewed the medical records of 22 children with sarcoidosis who applied to the Pediatric pulmonology department of Erciyes University Faculty of Medicine and Necmettin Erbakan Faculty of Medicine in 2012 and 2022. RESULTS The mean age of the patients at the time of diagnosis was 13.1/year (interquartile range [IQR]1:6.3-[IQR]3:15.7). The most common first presenting symptom was cough 40.9% (n = 9), weight loss 31.8% (n = 7), and dyspnea 22.7% (n = 5). There were elevated levels of C-reactive protein (CRP; 59%), angiotensin-converting enzyme (ACE; 54.5%), erythrocyte sedimentation rate (ESR; 54.5%), and immunoglobulin G (IgG; 54.5%). Twenty patients (90%) received systemic steroid treatment. Eighteen (81.8%) of these patients responded positively to treatment. Two patients had a recurrence. CONCLUSION The incidence of sarcoidosis in children in Turkey is currently unknown. However, a regional average of 2.2 cases per year has been documented for the first time. Contrary to previous studies, a significant prevalence of consanguineous marriage was observed in our study. While constitutional symptoms were most common in other studies, the cough was the most common symptom in our study. To our knowledge, this is one of the Turkish studies with the highest number of sarcoidosis in children and one of the few European studies on sarcoidosis in children.
Collapse
Affiliation(s)
- Melih Hangül
- Division of Pediatric Pulmonology, Department of Pediatrics, Erciyes University, Kayseri, Turkey
| | - Mehmet Köse
- Division of Pediatric Pulmonology, Department of Pediatrics, Erciyes University, Kayseri, Turkey
| | - Sevgi Pekcan
- Division of Pediatric Pulmonology, Department of Pediatrics, Necmettin Erbakan University, Konya, Turkey
| | - Ali Ersoy
- Division of Pediatric Pulmonology, Department of Pediatrics, Erciyes University, Kayseri, Turkey
| | - Gokcen Unal
- Division of Pediatric Pulmonology, Department of Pediatrics, Necmettin Erbakan University, Konya, Turkey
| | - Hanife Tugce Caglar
- Division of Pediatric Pulmonology, Department of Pediatrics, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
3
|
Chriswell ME, Fuhlbrigge RC, Lovell MA, Monson M, Bloom JL. Why so low? An unusual case of myositis in a child. Pediatr Rheumatol Online J 2023; 21:36. [PMID: 37072782 PMCID: PMC10111759 DOI: 10.1186/s12969-023-00816-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Sarcoidosis is characterized by non-caseating epithelioid granulomas in various tissues throughout the body, most commonly the lung. Non-caseating granulomas may be seen in skeletal muscle, though typically asymptomatic and under-recognized. While rare in children, there is a need to better characterize the disease and its management. Here we present a 12-year-old female with bilateral calf pain who was ultimately found to have sarcoid myositis. CASE PRESENTATION A 12-year-old female presented to rheumatology with significantly elevated inflammatory markers and isolated lower leg pain. MRI of the distal lower extremities demonstrated extensive bilateral myositis with active inflammation, atrophy, and to a lesser extent fasciitis. This distribution of myositis in a child garnered a broad differential requiring a systematic evaluation. Ultimately, muscle biopsy revealed non-caseating granulomatous myositis with perivascular inflammation, extensive muscle fibrosis, and fatty replacement of the muscle with a CD4+ T cell predominant, lymphohistiocytic infiltrate consistent with sarcoidosis. Review of histopathology from age 6 of an extraconal mass resected from her right superior rectus muscle further confirmed the diagnosis. She had no other clinical symptoms or findings of sarcoidosis. The patient improved significantly with methotrexate and prednisone, though flared again after self-discontinuation of medications and was subsequently lost to follow-up. CONCLUSION This is the second reported case of granulomatous myositis associated with sarcoidosis in a pediatric patient, and the first to present with a chief complaint of leg pain. Increased knowledge of pediatric sarcoid myositis within the medical community will enhance recognition of the disease, improve the evaluation of lower leg myositis, and advance outcomes for this vulnerable population.
Collapse
Affiliation(s)
- Meagan E Chriswell
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert C Fuhlbrigge
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark A Lovell
- Department of Pathology and Laboratory Services, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew Monson
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica L Bloom
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| |
Collapse
|
4
|
Aa JS, Toftedal P, Schultz JDH, Fast S. Severe laryngeal sarcoidosis in a child managed by intralesional steroid, debulking, and methotrexate. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2022. [DOI: 10.1080/23772484.2022.2153052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jesper Stensig Aa
- Department of Oto-Rhino-Laryngology Vejle, University Hospital of Southern Denmark, Denmark
| | - Peter Toftedal
- Odense University Hospital, Hans Christian Andersen Children's Hospital, Odense C, Denmark
| | | | - Søren Fast
- Private ENT specialist, Middelfart, Denmark
| |
Collapse
|
5
|
Vo NH, Shashi KK, Winant AJ, Liszewski MC, Lee EY. Imaging evaluation of the pediatric mediastinum: new International Thymic Malignancy Interest Group classification system for children. Pediatr Radiol 2022; 52:1948-1962. [PMID: 35476071 DOI: 10.1007/s00247-022-05361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/07/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
Mediastinal masses are commonly identified in the pediatric population with cross-sectional imaging central to the diagnosis and management of these lesions. With greater anatomical definition afforded by cross-sectional imaging, classification of mediastinal masses into the traditional anterior, middle and posterior mediastinal compartments - as based on the lateral chest radiograph - has diminishing application. In recent years, the International Thymic Malignancy Interest Group (ITMIG) classification system of mediastinal masses, which is cross-sectionally based, has garnered acceptance by multiple thoracic societies and been applied in adults. Therefore, there is a need for pediatric radiologists to clearly understand the ITMIG classification system and how it applies to the pediatric population. The main purpose of this article is to provide an updated review of common pediatric mediastinal masses and mediastinal manifestations of systemic disease processes in the pediatric population based on the new ITMIG classification system.
Collapse
Affiliation(s)
- Nhi H Vo
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kumar K Shashi
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Mark C Liszewski
- Department of Radiology and Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| |
Collapse
|
6
|
Lee SM, Choi H, Lim S, Shin J, Kang JM, Ahn JG. Pediatric Sarcoidosis Misdiagnosed as Hepatosplenic Abscesses: A Case Report and Review. JOURNAL OF RHEUMATIC DISEASES 2022; 29:181-186. [PMID: 37475968 PMCID: PMC10324926 DOI: 10.4078/jrd.2022.29.3.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/06/2021] [Accepted: 10/23/2021] [Indexed: 07/22/2023]
Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown etiology characterized by granuloma formation. Due to the limited incidence of sarcoidosis in pediatric patients, little is known about the clinical course of this disease. A combination of clinical, radiologic, and pathologic examination is necessary to exclude other differential diagnoses (i.e., infection and granulomatous inflammatory disorder) and establish a diagnosis of sarcoidosis. Here, we report a case of histologically confirmed sarcoidosis initially misdiagnosed as hepatosplenic abscesses in an 11-year-old male. Treatment with corticosteroids improved his symptoms and resolved his skin and hepatosplenic lesions. A three-year follow-up was uneventful. This study emphasizes the importance of considering sarcoidosis in children presenting with findings of multi-organ involvement in the presence of histologic evidence of granuloma.
Collapse
Affiliation(s)
- Su Min Lee
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyungwook Choi
- epartment of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungmin Lim
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jehee Shin
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Shivpuri A, Turtsevich I, Solebo AL, Compeyrot-Lacassagne S. Pediatric uveitis: Role of the pediatrician. Front Pediatr 2022; 10:874711. [PMID: 35979409 PMCID: PMC9376387 DOI: 10.3389/fped.2022.874711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
The challenges of childhood uveitis lie in the varied spectrum of its clinical presentation, the often asymptomatic nature of disease, and the evolving nature of the phenotype alongside normal physiological development. These issues can lead to delayed diagnosis which can cause significant morbidity and severe visual impairment. The most common ocular complications include cataracts, band keratopathy, glaucoma, and macular oedema, and the various associated systemic disorders can also result in extra-ophthalmic morbidity. Pediatricians have an important role to play. Their awareness of the various presentations and etiologies of uveitis in children afford the opportunity of prompt diagnosis before complications arise. Juvenile Idiopathic Arthritis (JIA) is one of the most common associated disorders seen in childhood uveitis, but there is a need to recognize other causes. In this review, different causes of uveitis are explored, including infections, autoimmune and autoinflammatory disease. As treatment is often informed by etiology, pediatricians can ensure early ophthalmological referral for children with inflammatory disease at risk of uveitis and can support management decisions for children with uveitis and possible underling multi-system inflammatory disease, thus reducing the risk of the development of irreversible sequelae.
Collapse
Affiliation(s)
- Abhay Shivpuri
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Inga Turtsevich
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ameenat Lola Solebo
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom.,University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sandrine Compeyrot-Lacassagne
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom
| |
Collapse
|
8
|
Amselem S, Gueguen S, Weinbach J, Clement A, Landais P. RaDiCo, the French national research program on rare disease cohorts. Orphanet J Rare Dis 2021; 16:454. [PMID: 34715889 PMCID: PMC8555205 DOI: 10.1186/s13023-021-02089-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) affect nearly 3 million people in France and at least 26-30 million people in Europe. These diseases, which represent a major medical concern, are mainly of genetic origin, often chronic, progressive, degenerative, life threatening and disabling, accounting for more than one third of all deaths occurring during infancy. In this context, there are needs for coordinated information on RDs at national/international levels, based on high quality, interoperable and sharable data. The main objective of the RaDiCo (Rare Disease Cohorts) program, coordinated by Inserm, was the development of RD e-cohorts via a national platform. The cohort projects were selected through a national call in 2014. The e-cohorts are supported by an interoperable platform, equivalent to an infrastructure, constructed on the "cloud computing" principle and in compliance with the European General Data Protection Regulation. It is dedicated to allow a continuous monitoring of data quality and consistency, in line with the French Health Data Hub. RESULTS Depending on cohorts, the objectives are to describe the natural history of the studied RD(s), identify the underlying disease genes, establish phenotype-genotype correlations, decipher their pathophysiology, assess their societal and medico-economic impact, and/or identify patients eligible for new therapeutic approaches. Inclusion of prevalent and incident cases started at the end of 2016. As of April 2021, 5558 patients have been included within 13 RD e-cohorts covering 67 diseases integrated in 10 European Reference Networks and contributing to the European Joint Program on RDs. Several original results have been obtained in relation with the secondary objectives of the RaDiCo cohorts. They deal with discovery of new disease genes, assessment of treatment management, deciphering the underlying pathophysiological mechanisms, diagnostic approaches, genotype-phenotype relationships, development and validation of questionnaires relative to disease burden, or methodological aspects. CONCLUSION RaDiCo currently hosts 13 RD e-cohorts on a sharable and interoperable platform constructed on the "cloud computing" principle. New RD e-cohorts at the European and international levels are targeted.
Collapse
Affiliation(s)
- Serge Amselem
- RaDiCo, Inserm, Trousseau Hospital, Paris, France
- Sorbonne Université, Inserm U933, Childhood Genetic Disorders, Trousseau Hospital, 26 rue du Dr. Arnold Netter, 75012 Paris, France
| | | | - Jérôme Weinbach
- Present Address: Direction Générale de La Santé, Ministry of Health, Paris, France
| | - Annick Clement
- RaDiCo, Inserm, Trousseau Hospital, Paris, France
- Department of Paediatric Respiratory Medicine, Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Paul Landais
- RaDiCo, Inserm, Trousseau Hospital, Paris, France
- EA2415, University Clinical Research Institute, Montpellier University, Montpellier, France
| | - for the RaDiCo Program
- RaDiCo, Inserm, Trousseau Hospital, Paris, France
- Sorbonne Université, Inserm U933, Childhood Genetic Disorders, Trousseau Hospital, 26 rue du Dr. Arnold Netter, 75012 Paris, France
- Department of Paediatric Respiratory Medicine, Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- EA2415, University Clinical Research Institute, Montpellier University, Montpellier, France
- Present Address: Direction Générale de La Santé, Ministry of Health, Paris, France
| |
Collapse
|
9
|
A Primer on the Clinical Aspects of Sarcoidosis for the Basic and Translational Scientist. J Clin Med 2021; 10:jcm10132857. [PMID: 34203188 PMCID: PMC8268437 DOI: 10.3390/jcm10132857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022] Open
Abstract
The immunopathogenesis of sarcoidosis remains unclear. This failure in understanding has been clinically impactful, as it has impeded the accurate diagnosis, treatment, and prevention of this disease. Unraveling the mechanisms of sarcoidosis will require input from basic and translational scientists. In order to reach this goal, scientists must have a firm grasp of the clinical aspects of the disease, including its diagnostic criteria, the immunologic defects, clinical presentations, response to therapy, risk factors, and clinical course. This manuscript will provide an overview of the clinical aspects of sarcoidosis that are particularly relevant for the basic and translational scientist. The variable phenotypic expression of the disease will be described, which may be integral in identifying immunologic disease mechanisms that may be relevant to subgroups of sarcoidosis patients. Data concerning treatment and risk factors may yield important insights concerning germane immunologic pathways involved in the development of disease. It is hoped that this manuscript will stimulate communication between scientists and clinicians that will eventually lead to improved care of sarcoidosis patients.
Collapse
|
10
|
Klaus R, Jansson AF, Griese M, Seeman T, Amann K, Lange-Sperandio B. Case Report: Pediatric Renal Sarcoidosis and Prognostic Factors in Reviewed Cases. Front Pediatr 2021; 9:724728. [PMID: 34589456 PMCID: PMC8475649 DOI: 10.3389/fped.2021.724728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Pediatric sarcoidosis is a complex inflammatory disorder with multisystemic manifestations. Kidney involvement in children is rare, and prognostic factors are unknown. Case Report and Methods: We report the case of a 16-year-old girl with multiorgan sarcoidosis and renal involvement. The patient presented with tubulointerstitial nephritis, acute kidney injury (AKI), chest CT disseminated noduli, granulomatous iridocyclitis, giant-cell sialadenitis, and arthralgia. The kidney biopsy revealed non-granulomatous interstitial nephritis. Treatment consisted of initial high-dose methylprednisolone pulse followed by oral prednisolone and methotrexate. Full remission was achieved. In addition, we performed a literature review using PubMed and analyzed data on pediatric renal sarcoidosis cases. Results: We identified 36 cases of pediatric sarcoidosis with renal involvement on presentation and data on the end-of-follow-up glomerular filtration rate (GFR). The data from the literature review showed that renal involvement was slightly more prevalent in males (60%). AKI was present in most of the described patients (84%). Oral prednisolone was used in 35 of 36 cases; in more severe cases, other immunosuppressants were used. We newly identified renal concentration impairment and granulomatous interstitial nephritis as factors with a clear trend toward GFR loss at the end of follow-up, emphasizing the importance of kidney biopsy in symptomatic patients. In contrast, higher GFR at presentation and hypercalcemia were rather favorable factors. According to the identified predictive factors, our patient has a good prognosis and is in remission. Conclusion: The factors indicating a trend toward an unfavorable renal outcome in pediatric sarcoidosis are renal concentration impairment and granulomatous interstitial nephritis at presentation, while a higher GFR is beneficial.
Collapse
Affiliation(s)
- Richard Klaus
- Division of Pediatric Nephrology, Department of Pediatrics, Dr. v. Hauner Children's Hospital Ludwig-Maximilians University, Munich, Germany
| | - Annette Friederike Jansson
- Department of Pediatrics, Dr. v. Hauner Children's Hospital Ludwig-Maximilians University, Munich, Germany
| | - Matthias Griese
- Department of Pediatrics, Dr. v. Hauner Children's Hospital Ludwig-Maximilians University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Tomas Seeman
- Division of Pediatric Nephrology, Department of Pediatrics, Dr. v. Hauner Children's Hospital Ludwig-Maximilians University, Munich, Germany
| | - Kerstin Amann
- Institute for Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Bärbel Lange-Sperandio
- Division of Pediatric Nephrology, Department of Pediatrics, Dr. v. Hauner Children's Hospital Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
11
|
Ditaranto R, Caponetti AG, Ferrara V, Parisi V, Minnucci M, Chiti C, Baldassarre R, Di Nicola F, Bonetti S, Hasan T, Potena L, Galiè N, Ragni L, Biagini E. Pediatric Restrictive Cardiomyopathies. Front Pediatr 2021; 9:745365. [PMID: 35145940 PMCID: PMC8822222 DOI: 10.3389/fped.2021.745365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is the least frequent phenotype among pediatric heart muscle diseases, representing only 2.5-3% of all cardiomyopathies diagnosed during childhood. Pediatric RCM has a poor prognosis, high incidence of pulmonary hypertension (PH), thromboembolic events, and sudden death, is less amenable to medical or surgical treatment with high mortality rates. In this scenario, heart transplantation remains the only successful therapeutic option. Despite a shared hemodynamic profile, characterized by severe diastolic dysfunction and restrictive ventricular filling, with normal ventricle ejection fraction and wall thickness, RCM recognizes a broad etiological spectrum, consisting of genetic/familial and acquired causes, each of which has a distinct pathophysiology and natural course. Hence, the aim of this review is to cover the causes, clinical presentation, diagnostic evaluation, treatment, and prognosis of pediatric RCM.
Collapse
Affiliation(s)
- Raffaello Ditaranto
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Angelo Giuseppe Caponetti
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentina Ferrara
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Vanda Parisi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Matteo Minnucci
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Chiara Chiti
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Riccardo Baldassarre
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Federico Di Nicola
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simone Bonetti
- Pediatric Cardiac Surgery and GUCH Unit, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Tammam Hasan
- Pediatric Cardiac Surgery and GUCH Unit, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luciano Potena
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luca Ragni
- Pediatric Cardiac Surgery and GUCH Unit, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Elena Biagini
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
12
|
ATS Core Curriculum 2020. Pediatric Pulmonary Medicine. ATS Sch 2020; 1:456-475. [PMID: 33870313 PMCID: PMC8015762 DOI: 10.34197/ats-scholar.2020-0022re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine, in a 3- to 4-year recurring cycle of topics. These topics will be presented at the 2020 International Conference. Below is the pediatric pulmonary medicine core, including pediatric hypoxemic respiratory failure; modalities in noninvasive management of chronic respiratory failure in childhood; surgical and nonsurgical management of congenital lung malformations; an update on smoke inhalation lung injury; an update on vaporizers, e-cigarettes, and other electronic delivery systems; pulmonary complications of sarcoidosis; pulmonary complications of congenital heart disease; and updates on the management of congenital diaphragmatic hernia.
Collapse
|
13
|
Rahman N, Petrushkin H, Solebo AL. Paediatric autoimmune and autoinflammatory conditions associated with uveitis. Ther Adv Ophthalmol 2020; 12:2515841420966451. [PMID: 33225212 PMCID: PMC7649876 DOI: 10.1177/2515841420966451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Childhood uveitis comprises a collection of heterogenous ocular phenotypes which are associated with a diverse range of childhood autoimmune and autoinflammatory disorders. Of these genetic and/or acquired disorders, juvenile idiopathic arthritis is the most common, affecting 30-80% of children with uveitis. Up to a third of children with uveitis have 'isolated' idiopathic disease and do not have an associated systemic disease which manifests in childhood. However, uveitis may be the presenting manifestation of disease; thus, the apparently well child who presents with uveitis may have isolated idiopathic disease, but they may have an evolving systemic disorder. The diagnosis of most of the associated disorders is reliant on clinical features rather than serological or genetic investigations, necessitating detailed medical history taking and systemic examination. Adequate control of inflammation is key to good visual outcomes, and multidisciplinary care is key to good broader health outcomes.
Collapse
Affiliation(s)
- Najiha Rahman
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ameenat Lola Solebo
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| |
Collapse
|
14
|
Valeyre D, Bernaudin JF. Management of Sarcoidosis, a Selection of Topical Items Updating. J Clin Med 2020; 9:jcm9103220. [PMID: 33036457 PMCID: PMC7599542 DOI: 10.3390/jcm9103220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Dominique Valeyre
- UMR INSERM 1272 Université Sorbonne Paris Nord, 93000 Bobigny, France;
- APHP Hôpital Avicenne, 93000 Bobigny, France
- Groupe Hospitalier Paris-Saint Joseph, 75014 Paris, France
- Correspondence:
| | - Jean-François Bernaudin
- UMR INSERM 1272 Université Sorbonne Paris Nord, 93000 Bobigny, France;
- APHP Hôpital Avicenne, 93000 Bobigny, France
- Faculté de Médecine, Sorbonne Université, 75013 Paris, France
| |
Collapse
|
15
|
Child-Adult Transition in Sarcoidosis: A Series of 52 Patients. J Clin Med 2020; 9:jcm9072097. [PMID: 32635292 PMCID: PMC7408766 DOI: 10.3390/jcm9072097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/16/2020] [Accepted: 06/20/2020] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Pediatric sarcoidosis is a rare and mostly severe disease. Very few pediatric series with a prolonged follow-up are reported. We aimed to evaluate the evolution of pediatric sarcoidosis in adulthood. (2) Material and methods: Patients over 18-years-old with a pediatric-onset sarcoidosis (≤15-year-old) who completed at least a three-year follow-up in French expert centers were included. Clinical information at presentation and outcome in adulthood were studied. (3) Results: A total of 52 patients were included (34 prospectively in childhood and 18 retrospectively in adulthood), with a mean age of 12 (±2.7) at diagnosis. The median duration time of follow-up was 11.5 years (range 3–44.5). Relapses mostly occurred during treatment decrease (84.5%), others within the three years after treatment interruption (9.1%), and rarely when the disease was stable for more than three years (6.4%). Sarcoidosis was severe in 11 (21.2%) in adulthood. Patients received a high corticosteroid cumulative dose (median 17,900 mg) for a median duration of five years (range 0–32), resulting in mostly mild (18; 35.3%) and rarely severe (2; 3.8%) adverse events. (4) Conclusions: Pediatric-onset sarcoidosis needed a long-term treatment in almost half of the patients. Around one fifth of pediatric-onset sarcoidosis patients had severe sarcoidosis consequences in adulthood.
Collapse
|
16
|
Mărginean CO, Meliţ LE, Grigorescu G, Puiac C, Simu I. Hypercalcemia, an Important Puzzle Piece in Uncommon Onset Pediatric Sarcoidosis-A Case Report and a Review of the Literature. Front Pediatr 2020; 8:497. [PMID: 32984210 PMCID: PMC7479091 DOI: 10.3389/fped.2020.00497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis (SD) is a systemic granulomatous condition that is especially encountered in young adults and rarely in children, affecting predominantly the lungs and lymph nodes. We report the case of a 14-year-old teenage boy admitted to our clinic for nausea, vomiting, and weight loss. Clinical examination at the time of admission revealed malaise, pallor, and abdominal tenderness in the epigastric area at palpation. Laboratory tests revealed an elevated level of hemoglobin, mild thrombocytosis, increased erythrocyte sedimentation rate, and a mild increase in creatinine and urea levels along with hypercalcemia. An abdominal ultrasound revealed a right ectopic kidney, whereas the upper digestive endoscopy showed intense hyperemia and edema of the gastric mucosa. Thoracic computed tomography scan revealed giant hilar and mediastinal lymphadenopathy, along with multiple micronodules within the lung parenchyma and ground-glass aspect. The level of angiotensin-converting enzyme was high, parathormone was normal, and vitamin D level was low. Pathological examination of the bronchial, mediastinal, and lung biopsies established the diagnosis of SD. We administered oral corticosteroids for 2 months with outstandingly favorable outcome and no signs of recurrence 6 months after the cessation of the therapy.
Collapse
Affiliation(s)
- Cristina Oana Mărginean
- Department of Pediatrics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Lorena Elena Meliţ
- Department of Pediatrics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Gabriel Grigorescu
- Pneumology Clinic, County Emergency Hospital Târgu Mureș, Târgu Mureș, Romania
| | - Claudiu Puiac
- Department of Emergency Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Iunius Simu
- Department of Radiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| |
Collapse
|
17
|
Sergi CM. Lower Respiratory Tract. PATHOLOGY OF CHILDHOOD AND ADOLESCENCE 2020:139-253. [DOI: 10.1007/978-3-662-59169-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|