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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.
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Affiliation(s)
| | - Renaz Sabir Saleh
- Dentistry DepartmentKomar University of Science and TechnologyKurdistanIraq
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Khavandgar Z, Warner BM, Baer AN. Evaluation and management of dry mouth and its complications in rheumatology practice. Expert Rev Clin Immunol 2024; 20:1-19. [PMID: 37823475 PMCID: PMC10841379 DOI: 10.1080/1744666x.2023.2268283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The symptom of dry mouth has multiple potential etiologies and can be a diagnostic clue to the presence of common systemic diseases encountered in rheumatology practice. The presence of decreased saliva flow (i.e. salivary hypofunction) defines a subset of dry mouth patients in whom there may be reversible drug effects, an iatrogenic insult such as head and neck irradiation, or a disease that directly involves the salivary glands (e.g. Sjögren's disease). The assessment of salivary hypofunction includes sialometry, salivary gland imaging, salivary gland biopsy, and an assessment for relevant systemic diseases. Optimal management of dry mouth requires accurate definition of its cause, followed by general measures that serve to alleviate its symptoms and prevent its complications. AREAS COVERED Through a literature search on xerostomia and salivary hypofunction, we provide an overview of the causes of dry mouth, highlight the potential impact of salivary hypofunction on oral and systemic health, detail routine evaluation methods and treatment strategies, and emphasize the importance of collaboration with oral health care providers. EXPERT OPINION Our Expert Opinion is provided on unmet needs in the management of dry mouth and relevant research progress in the field.
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Affiliation(s)
- Zohreh Khavandgar
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Blake M. Warner
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Alan N. Baer
- Johns Hopkins University School of Medicine, Baltimore, MD
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Ike RW, McCoy SS, Kalunian KC. What Bedside Skills Could the Modern Rheumatologist Possess? Part II. "Certain Technical Procedures". J Clin Rheumatol 2023:00124743-990000000-00172. [PMID: 37983677 DOI: 10.1097/rhu.0000000000002022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT Rheumatologists have never been reluctant to adopt procedures that might enhance their diagnostic or therapeutic powers. Their propensity to penetrate the joints of the patients they were treating set them apart from the general internist. Since the 1980s, when a chance to look inside the joints they were treating attracted a few rheumatologists, other things that could be done at the bedside emerged with now an array of bedside procedures that could be part of a rheumatologist's skill set. Besides gains in diagnosis and/or therapy, each constitutes a chance to restore the physical contact between physician and patient, riven by factors of the last decade, such as electronic medical records and COVID. With such contact so important to satisfaction of the patient and physician alike, acquisition of proficiency in certain technical procedures described herein offers one path to begin restoring rheumatology to the richly fulfilling practice it once was.
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Affiliation(s)
- Robert W Ike
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System, Ann Arbor, MI
| | - Sara S McCoy
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison, Madison, WI
| | - Kenneth C Kalunian
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of California at San Diego, San Diego, CA
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Ike RW, McCoy SS. Bedside labial salivary gland biopsy (LSGBx: Lip biopsy): An update for rheumatologists. Best Pract Res Clin Rheumatol 2023; 37:101839. [PMID: 37271612 DOI: 10.1016/j.berh.2023.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023]
Abstract
Retrieval of minor salivary glands from a labial submucosal site through a minimally invasive bedside procedure was first described nearly 60 years ago and remains an attractive alternative to more invasive surgical procedures to obtain salivary gland tissue for pathologic examination. Examination of glands for features of Sjögren's has constituted the primary use of this procedure but other systemic disorders can affect minor salivary glands and their diagnoses can be supported by biopsy. Performance of the procedure does not require specialized training in head and neck surgery or dentistry, only simple wound closure skills. Skill in performing the procedure enables the clinician to acquire potentially diagnostic material without the need for referral while offering immediate expert feedback to the patient being biopsied. Material obtained at biopsy can also be the focus of research investigations.
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Affiliation(s)
- Robert W Ike
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, United States.
| | - Sara S McCoy
- Department of Medicine, Rheumatology Division, University of Wisconsin - Madison, Madison, United States.
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Carvajal Alegria G, Depinoy T, Devauchelle-Pensec V, Jousse-Joulin S, Marhadour T, Guellec D, Marcorelles P, Pers JO, Saraux A, Cornec D. Diagnostic utility of a second minor salivary gland biopsy in patients with suspected Sjögren's syndrome: A retrospective cohort study. Joint Bone Spine 2023; 90:105459. [PMID: 36108904 DOI: 10.1016/j.jbspin.2022.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 09/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether repeated minor salivary gland biopsy (MSGB) has a clinical diagnostic utility in patients with suspicion of Sjögren's syndrome (SS). METHODS Clinical, biological, pathological data and physician's diagnosis after each MSGB from patients with suspected primary or secondary SS who had benefited from 2 MSGB at Brest University Hospital between January 1st, 1990 and January 14th, 2015, were retrospectively collected. We compared the characteristics of patients with and without first positive MSGB, concordance between the MSGB, and analyzed the modifications of diagnosis after the second MSGB. RESULTS Ninety-three patients were included, first MSGB was positive for 23 and negative for 70. Patients with first positive MSGB had more often renal involvement (P<0.05) and hypergammaglobulinemia (P=0.01), anti-SSA antibodies (P<0.05) and positive second biopsy with focus score ≥ 1 or Chisholm>2 (P<0.01). The mean time between the 2 MSGB was 5.7±4.3 years. The concordance between the results of the 2 biopsies was low (κ = 0.34). MSGB influenced diagnostic's change in 10 cases where the second MSGB was always guided by new specific clinical manifestations. CONCLUSION We observed a low concordance between 2 MSGB in patients with suspected pSS in our study. Despite this variability, performing a second MSGB changed the initial diagnosis in only a minority of the patients and was particularly useful when clinical manifestations had deeply evolved.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thibaud Depinoy
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thierry Marhadour
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Dewi Guellec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; CIC Inserm 1412, CHRU de Brest, Brest, France
| | | | - Jacques-Olivier Pers
- Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Alain Saraux
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Divi Cornec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France.
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Bautista-Vargas M, Vivas AJ, Tobón GJ. Minor salivary gland biopsy: Its role in the classification and prognosis of Sjögren's syndrome. Autoimmun Rev 2020; 19:102690. [PMID: 33099041 DOI: 10.1016/j.autrev.2020.102690] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022]
Abstract
Sjögren's syndrome (SS) is an autoimmune disorder characterized by mononuclear cell infiltration in the exocrine glands, which leads to sicca syndrome (xerostomia and xerophthalmia). The etiology of SS is unknown, but multiple environmental factors (infectious, hormonal and stress-related), as well as genetic factors, may play a role in its pathogenesis. The diagnosis of SS is complex considering its clinical and paraclinical parameters may not be very specific. The minor salivary gland biopsy (MSGB) has undoubtedly become crucial for classifying and determining the prognosis of SS. The three main different classification systems for its interpretation have been described by Chisholm and Mason, Greenspan and Daniels, and Tarpley. However, this invasive procedure has variable sensitivity and specificity as well as low reproducibility. The use of additional methods, such as skin biopsy, imaging techniques, and serum/salivary biomarkers, may be combined with current methods to develop a bioscore that could increase diagnostic performance. In this review, we summarized the main pathological findings in SS and the prognosis of patients with SS according to the biopsy results.
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Affiliation(s)
- Mario Bautista-Vargas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Alvaro J Vivas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Gabriel J Tobón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.
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Handra-Luca A. Granuloma of the labial minor salivary glands in tuberculosis. J Oral Maxillofac Pathol 2018; 22:150. [PMID: 29731582 PMCID: PMC5917533 DOI: 10.4103/jomfp.jomfp_137_15] [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: 11/22/2022] Open
Abstract
Minor salivary gland granuloma is rare in tuberculosis. We present a case of labial minor salivary gland granulomas occurring in the course of tuberculosis along with skin, mediastinal and liver granulomas. The patient (46-year-old man) presented with asthenia, nocturne transpiration, weight loss and compressive thoracic adenopathies. The angiotensin I converting enzyme was elevated as well as calcemia. The QuantiFERON test and culture of a mediastinal specimen were positive for Mycobacterium tuberculosis. Multinucleated-cell-granulomas (focally with necrosis) were identified on skin, mediastinal, liver and minor salivary gland biopsies. Kidney biopsy was suggestive of IgA-glomerulonephritis. Treatment (isoniazid, rifampicin, ethambutol and moxifloxacin) was started and corticoids 15 days afterward. At 1 year, the patient had recovered. In conclusion, a case of labial minor salivary gland granulomas occurring in the course of tuberculosis is reported. Tuberculosis should be included in the differential diagnoses of labial minor salivary gland granulomas as treatments may be more complex than those for other granulomas including sarcoidosis.
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Affiliation(s)
- Adriana Handra-Luca
- Department of Pathology, APHP Avicenne Hospital, University Paris Nord Sorbonne Cite, France
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8
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Bowers L, Brennan M. Oral Complications of Multiorgan Disorders. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:187-195. [PMID: 28778307 DOI: 10.1016/j.cxom.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leah Bowers
- Oral and Maxillofacial Surgery, UCSF School of Dentistry, 533 Parnassus Avenue, PO Box 0404, UB-10, San Francisco, CA 94143, USA.
| | - Michael Brennan
- Department of Oral Medicine, Carolinas Medical Center, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
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Sarcoidosis in the Head and Neck: An Illustrative Review of Clinical Presentations and Imaging Findings. AJR Am J Roentgenol 2017; 208:66-75. [DOI: 10.2214/ajr.16.16058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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10
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Abstract
Sarcoidosis is a diagnosis of exclusion; there exists neither a pathognomonic clinical feature nor a perfect diagnostic test. Missed diagnosis and overdiagnosis are common. A careful history and physical examination look for "footprints" of sarcoidosis or features suggesting alternative diagnoses. Some presentations are classic and do not require tissue confirmation. A tissue biopsy should be performed if doubt exists. Sampling intrathoracic disease by transbronchial or ultrasound-guided biopsy of mediastinal lymph nodes provide high diagnostic yield with low complication rates. Even with tissue confirmation, diagnosis is never secure and follow-up is required to be fully confident of the diagnosis.
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11
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Delcey V, Morgand M, Lopes A, Mouly S, Jarrin I, Sellier P, Wassef M, Bergmann JF. [Prevalence of granulomatous lesions in minor salivary gland biopsy in a case series of 65 patients with tuberculosis]. Rev Med Interne 2015; 37:80-3. [PMID: 26321225 DOI: 10.1016/j.revmed.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 06/15/2015] [Accepted: 07/25/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The distinction between tuberculosis (TB), a worldwide infectious granulomatosis requiring specific antibiotic therapy, and sarcoidosis, a rare granulomatous disease that may require corticosteroids is not straightforward and may result in diagnostic and therapeutic delay. METHODS We prospectively and consecutively evaluated the presence of epithelioid granulomas in minor salivary gland biopsy of 65 consecutive patients with TB. RESULTS In our study, 10.8 % of our TB patients had epithelioid granulomas without caseous necrosis identified in their minor salivary gland biopsy, regardless of the location of TB, HIV status and whether or not the sputum examination was positive for tuberculous bacilli. CONCLUSION The presence of epithelioid granulomas in minor salivary gland biopsy may not be helpful to the clinician to rule out TB in a patient with suspected sarcoidosis.
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Affiliation(s)
- V Delcey
- Service de médecine interne A, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Morgand
- Service de médecine interne A, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - A Lopes
- Service de médecine interne A, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Mouly
- Service de médecine interne A, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - I Jarrin
- Service de médecine interne A, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Sellier
- Service de médecine interne A, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Wassef
- Service d'anatomopathologie, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-F Bergmann
- Service de médecine interne A, université Sorbonne Paris Cité-Diderot, groupe hospitalier Lariboisière-Fernand-Widal, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
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Abstract
Patients with salivary gland disease present with certain objective and/or subjective signs. An accurate diagnosis for these patients requires a range of techniques that includes the organized integration of information derived from their history, clinical examination, imaging, serology, and histopathology. This article highlights the signs and symptoms of the salivary gland disorders seen in the Salivary Gland Center, and emphasizes the methodology used to achieve a definitive diagnosis and therapy.
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Affiliation(s)
- Louis Mandel
- Department of Oral and Maxillofacial Surgery, Salivary Gland Center, Columbia University College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA.
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13
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Jamilloux Y, Kodjikian L, Broussolle C, Sève P. Sarcoidosis and uveitis. Autoimmun Rev 2014; 13:840-9. [DOI: 10.1016/j.autrev.2014.04.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 03/30/2014] [Accepted: 03/30/2014] [Indexed: 12/23/2022]
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14
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Jamilloux Y, Bonnefoy M, Valeyre D, Varron L, Broussolle C, Sève P. Elderly-onset sarcoidosis: prevalence, clinical course, and treatment. Drugs Aging 2014; 30:969-78. [PMID: 24197607 DOI: 10.1007/s40266-013-0125-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sarcoidosis is a systemic disorder of unknown cause characterized by its pathological hallmark, the non-caseating granulomas, and by variable clinical course. While most of the cases affect people aged between 25 and 40 years, approximately 30 % of cases occur in older patients. Elderly-onset sarcoidosis (EOS) is defined as the onset of sarcoidosis in people over 65 years of age. Specific studies on the incidence and prevalence of sarcoidosis in this subgroup are scarce. Several studies suggest that the clinical features of EOS differ from those of sarcoidosis in younger patients. Compared with younger patients, fatigue, uveitis and specific skin lesions are more common, while erythema nodosum and chest x-ray abnormalities are less frequent. The diagnosis of EOS is challenging and may be delayed for many months because of its insidious onset, low prevalence and similarity to other more common disorders. When there is a granulomatous reaction in the elderly, clinicians should doubt the diagnosis and first think of tuberculosis, neoplasia or rare settings such as granulomatosis with polyangiitis or granulomatous reaction due to interferon and tumour necrosis factor-α (TNFα) blockers. A minor salivary gland biopsy also has a higher accuracy for diagnosis in the elderly. The current management of EOS remains empiric because of the lack of randomized, controlled studies. However, the approach to treatment is similar, regardless of the age of the patient. The treatment may be complicated by co-morbidities and increased risk of toxicities from usual treatments, particularly steroids. This review discusses the epidemiology, clinical course, prognosis and treatment of EOS.
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Affiliation(s)
- Yvan Jamilloux
- Department of Internal Medicine, Hopital de la Croix-Rousse, Claude Bernard University Lyon I, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
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Bernard C, Kodjikian L, Bancel B, Isaac S, Broussolle C, Seve P. Ocular sarcoidosis: when should labial salivary gland biopsy be performed? Graefes Arch Clin Exp Ophthalmol 2012; 251:855-60. [DOI: 10.1007/s00417-012-2178-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 10/03/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022] Open
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Abstract
Salivary gland abnormalities and salivary dysfunction are important orofacial disorders. Patients with such problems are usually seen in the dental office for evaluation and therapy, and the dental practitioner is required to make a diagnosis and institute care. Therefore, it is necessary for the dentist to be knowledgeable regarding the more common pathologic entities that involve the salivary apparatus, and also be familiar with the diagnostic and therapeutic tools that are available. Successful diagnosis is dependent on the organized integration of the information derived from past history, clinical examination, salivary volume study, imaging, serology, and histopathologic examination. This article discusses the most common disorders seen in the Salivary Gland Center and indicates the current approaches to diagnosis. Improvement in diagnostic skills will avoid serious complications and lead to specific and effective therapy.
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Affiliation(s)
- Louis Mandel
- College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA.
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18
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HUO AP, LIN KC, CHOU CT. Predictive and prognostic value of antinuclear antibodies and rheumatoid factor in primary Sjogren’s syndrome. Int J Rheum Dis 2010; 13:39-47. [DOI: 10.1111/j.1756-185x.2009.01444.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Weinreb RN, Lipson BK, Ryder MI, Freeman W. Diagnostic Testing in Ophthalmic Sarcoidosis. Semin Ophthalmol 2009. [DOI: 10.3109/08820538709068808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Poate TWJ, Sharma R, Moutasim KA, Escudier MP, Warnakulasuriya S. Orofacial presentations of sarcoidosis – a case series and review of the literature. Br Dent J 2008; 205:437-42. [DOI: 10.1038/sj.bdj.2008.892] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2008] [Indexed: 11/10/2022]
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Caporali R, Bonacci E, Epis O, Bobbio-Pallavicini F, Morbini P, Montecucco C. Safety and usefulness of minor salivary gland biopsy: Retrospective analysis of 502 procedures performed at a single center. ACTA ACUST UNITED AC 2008; 59:714-20. [DOI: 10.1002/art.23579] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Forooghian F, Gupta R, Wong DT, Derzko-Dzulynsky L. Anterior uveitis investigation by Canadian ophthalmologists: insights from the Canadian National Uveitis Survey. Can J Ophthalmol 2006; 41:576-83. [PMID: 17016528 DOI: 10.1016/s0008-4182(06)80026-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anterior uveitis can be the result of a number of underlying etiologies and is commonly seen in ophthalmology practice. The clinician must choose from a battery of potential investigations. A nonselective approach to testing is costly and inefficient and can lead to misinterpretation of false positive results. The purpose of this study was to identify investigation patterns of ophthalmologists in Canada for anterior uveitis and to make evidence-based recommendations for appropriate tests that could lead to improved patient care and more cost-effective use of health care resources. METHODS A cross-sectional survey of practicing ophthalmologists, fellows, and residents in Canada was conducted in September 2004. The survey instrument was an 11-item questionnaire mailed to 1196 physicians in Canada. RESULTS A total of 498 (42%) physicians responded to the survey. A wide range of tests were chosen when respondents were presented with 5 scenarios for anterior uveitis and asked what investigations they would order. Many of these tests have low diagnostic yields because they lack the sensitivity and specificity to be used as routine investigations in the setting of anterior uveitis. INTERPRETATION Increased education and awareness could lead to more cost-effective and efficient investigations in the setting of anterior uveitis. On the basis of evidence from a review of the literature, we make recommendations for investigations that should be considered in patients with anterior uveitis.
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Affiliation(s)
- Farzin Forooghian
- Department of Ophthalmology and Vision Sciences, University of Toronto, Hospital for Sick Children, Ontario, Canada.
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Abstract
BACKGROUND Sarcoidosis is a multifactorial systemic inflammatory disorder of unknown origin characterized by many potential signs and symptoms, as well as by the presence of noncaseating granulomas in the organs involved. Sarcoidosis also may manifest in the oral and maxillofacial region. CASE DESCRIPTION The authors describe a patient with xerostomia, dysgeusia, oral burning, xerophthalmia and bilateral parotid enlargement. She was diagnosed as having systemic sarcoidosis on the basis of the histologic findings of a biopsy of the labial minor salivary gland, as well as subsequent diagnostic evalutons. CONCLUSION AND CLINICAL IMPLICATIONS Enlargement of major salivary glands may be the first sign of sarcoidosis in a patient with few other symptoms or clinical findings suggestive of the disease. This case emphasizes the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling associated with xerostomia. It also highlights the dentist's potential role in the diagnosis and dental treatment of patients with systemic sarcoidosis.
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Affiliation(s)
- Mahnaz Fatahzadeh
- Department of Diagnostic Sciences, University of Medicine & Dentistry of New Jersey--New Jersey Dental School, Newark 07103, USA.
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Mandel L, Wolinsky B, Chalom EC. Treatment of refractory sarcoidal parotid gland swelling in a previously reported unresponsive case. J Am Dent Assoc 2005; 136:1282-5. [PMID: 16196234 DOI: 10.14219/jada.archive.2005.0345] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sarcoidosis is a multisystem granulomatous disease that is seen occasionally in patients with characteristic bilateral parotid gland swelling. Conventional therapy has involved either no treatment because of spontaneous remission or corticosteroids when organ involvement is severe. CASE DESCRIPTION The authors describe a previously published case report of a patient with sarcoidosis with parotid gland swellings who did not respond to standard therapy. Despite the use of various immunosuppressive agents, the swellings failed to resolve over a three-year period. It was only after a newly recommended agent, infliximab, was used that the patient's condition was treated successfully. CLINICAL IMPLICATIONS It is important for dental practitioners to be familiar with manifestations of sarcoidosis, particularly its salivary gland aspects. Inherent in the knowledge of the disease is the therapeutic approach to both routine and recalcitrant
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Affiliation(s)
- Louis Mandel
- Salivary Gland Center, School of Dental and Oral Surgery, Columbia University, New York, NY 10032, USA.
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Abstract
Sarcoidosis is a common systemic granulomatous disease affecting multiple organs. Oral involvement is relatively rare and, to our knowledge, there have been only 64 cases reported in the English literature. Most cases of oral sarcoidosis present with mobility of the teeth due to rapid alveolar bone loss. Other oral manifestations include asymptomatic swelling of the involved mucosa, gingivitis and ulcers. Diagnosis of sarcoidosis is by exclusion as no specific test is available. Radiographic, biochemical and histological findings are non-specific, but helpful. All cases of sarcoidosis do not require treatment. Corticosteroids are the treatment of choice in patients requiring treatment. Other drugs such as chloroquine, methotrexate, infliximab and thalidomide are also used in the treatment of sarcoidosis. In most of the oral cases reported, systemic steroids and surgery were the preferred treatment.
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Affiliation(s)
- L Suresh
- Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo, NY 14214, USA
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Vairaktaris E, Vassiliou S, Yapijakis C, Papakosta V, Kavantzas N, Martis C, Patsouris E. Salivary gland manifestations of sarcoidosis: report of three cases. J Oral Maxillofac Surg 2005; 63:1016-21. [PMID: 16003631 DOI: 10.1016/j.joms.2005.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Irié T, Maeda Y, Aida T, Sumitani K, Nagumo M, Tachikawa T. Multiple granulomatous inflammation in the minor salivary glands: a proposed new entity, allergic granulomatous sialadenitis. Pathol Int 2005; 54:850-3. [PMID: 15533228 DOI: 10.1111/j.1440-1827.2004.01768.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a patient who presented with multiple small submucosal nodules with granulomatous inflammation in the minor salivary glands of the oral cavity. A 43-year-old woman presented with a 1-week history of multiple small submucosal nodules in her oral cavity after having taken medicine for abdominal pain. The patient did not have a history of fever, rectal bleeding, skin lesions or arthritis, but did have a history of drug allergy and bronchial asthma. Histopathological examination of the submucosal nodules showed sialadenitis with marked infiltration of lymphocytes, eosinophilic cells, macrophages and Langhans-type or foreign-body-type multinucleate giant cells. The macrophages tended to be aggregated and appeared to have caused immature granuloma formation without caseous necrosis. Degranulated eosinophilic cells were numerous. Sarcoidosis, Crohn's disease, tuberculosis and atypical mycobacterial infection were not identified by medical examination. Three weeks after discontinuing the medication the patient was seen again at a follow-up visit. Multiple submucosal small nodules and other symptoms were not evident at that time. This case report may represent a new entity of salivary gland disease that we tentatively refer to as 'allergic granulomatous sialadenitis'.
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Affiliation(s)
- Tarou Irié
- Department of Oral Pathology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
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Ramos-Casals M, Brito-Zerón P, García-Carrasco M, Font J. Sarcoidosis or Sjögren syndrome? Clues to defining mimicry or coexistence in 59 cases. Medicine (Baltimore) 2004; 83:85-95. [PMID: 15028962 DOI: 10.1097/01.md.0000121237.98962.1e] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We present 5 new cases of coexisting sarcoidosis and Sjögren syndrome (SS) and review the literature for additional cases in order to analyze the clinical, immunologic, and histologic characteristics that may help physicians differentiate the mimicry of SS by sarcoidosis from a true coexistence of both autoimmune diseases. We considered the coexistence of sarcoidosis with SS to be when patients presented specific histologic patterns of both diseases, simultaneously or at different times.Fifty-nine patients were included in the analysis (54 identified in the literature search plus our 5 unpublished cases): 49 (83%) patients were female and 10 (17%) were male, with a mean age at diagnosis of 50 years. According to the histopathologic examination of the exocrine glands performed in 53 cases, we defined coexistence of sarcoidosis and SS in 28 cases, while in the remaining 25 patients, sarcoidosis mimicked SS. Clues to identifying when sarcoidosis coexists with SS were a higher prevalence of systemic manifestations (arthritis and uveitis) and positive immunologic parameters (antinuclear antibodies, rheumatoid factor, and anti-Ro/SS-A), as well as the existence of a focal sialadenitis (Chisholm-Mason score grades III-IV, with a CD4+ lymphocytic infiltration) in the salivary gland biopsy. In patients first diagnosed with primary SS, the appearance of some clinical features such as hilar adenopathies, uveitis, or hypercalcemia leads to the diagnosis of coexisting sarcoidosis. A careful application of the new American-European consensus criteria had a sensitivity of 93% and a specificity of 92% in identifying when SS coexists with sarcoidosis.In conclusion, the association of sarcoidosis with SS leads to a true coexistence of both diseases in more than half the patients described in the literature, while in the remaining patients, sarcoidosis mimics SS. In light of these results, sarcoidosis should not be considered as an exclusion criterion for the diagnosis of SS, and in patients with a suspected overlap of the two diseases, application of the new American-European consensus criteria for diagnosis of SS should be mandatory.
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Affiliation(s)
- Manuel Ramos-Casals
- From Department of Autoimmune Diseases (MR-C, PB-Z, MG-C, JF),Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, Barcelona, Spain; and Rheumatology Department of School of Medicine (MG-C), University of Puebla, Puebla, Mexico
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Radfar L, Kleiner DE, Fox PC, Pillemer SR. Prevalence and clinical significance of lymphocytic foci in minor salivary glands of healthy volunteers. ARTHRITIS AND RHEUMATISM 2002; 47:520-4. [PMID: 12382301 DOI: 10.1002/art.10668] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the prevalence and severity of focal lymphocytic sialadenitis in minor salivary glands of healthy, asymptomatic individuals, in whom Sjögren's syndrome (SS) has been excluded. METHODS Charts of 54 healthy volunteers who had salivary gland biopsies at the National Institutes of Health from January 1992 to August 1998 were reviewed. The healthy volunteers served as control subjects in various studies of salivary dysfunction. Significant medical conditions including SS were excluded. A biopsy with a focus score (FS) >1 was regarded as positive. Descriptive statistics were used to summarize the population's characteristics. RESULTS The frequency of focal lymphocytic infiltration in the healthy volunteers was about 15% (8 of 54). None of these individuals had subjective xerostomia or dry eyes. The positive FS ranged from 2 to 6. FS did not correlate with age, smoking, serologic findings, or salivary flow in these patients. CONCLUSION Lymphocytic infiltration in minor salivary glands is not uncommon among individuals without a history of salivary gland dysfunction. This finding is in agreement with the result of a previous autopsy survey study, indicating that focal sialadenitis may occur in the absence of SS.
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Affiliation(s)
- Lida Radfar
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA.
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Abstract
BACKGROUND Sarcoidosis is a multisystem granulomatous disease characteristically causing bilateral hilar lymphadenopathy. Salivary gland swellings also are seen, which mandate recognition by the dental profession. CASE DESCRIPTION The authors describe a patient whose diagnosis of sarcoidosis was tenuous. Ocular involvement and an elevated serum angiotensin-converting enzyme level suggested a diagnosis of sarcoidosis. Confirmation with a tissue biopsy was achieved only when the clinicians recognized that salivary gland swelling probably represented a manifestation of the disease. Steroid therapy was instituted. CLINICAL IMPLICATIONS It is important for the dental practitioner to be familiar with the salivary gland manifestation of sarcoidosis. Early recognition and intervention aborts or slows disease progression.
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Mandel L, Surattanont F. Bilateral parotid swelling: a review. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:221-37. [PMID: 11925529 DOI: 10.1067/moe.2002.121163] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Louis Mandel
- Salivary Gland Center, Columbia University School of Dental and Oral Surgery, New York-Presbyterian Hospital, Columbia Campus, New York, NY 10032, USA
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32
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Folwaczny M, Sommer A, Sander CA, Kellner H. Parotid sarcoidosis mimicking Sjögren's syndrome: report of a case. J Oral Maxillofac Surg 2002; 60:117-20. [PMID: 11757024 DOI: 10.1053/joms.2002.29128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Folwaczny
- Department of Operative Dentistry and Periodontology, Ludwig-Maximilians University, Munich, Germany.
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Batal H, Chou LL, Cottrell DA. Sarcoidosis: medical and dental implications. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:386-90. [PMID: 10519742 DOI: 10.1016/s1079-2104(99)70049-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Batal
- Boston University School of Dental Medicine, Department of Oral & Maxillofacial Surgery, MA 02118, USA
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Abstract
This article reviews the pathology of sarcoidosis that covers the general and systemic aspects of the disease. Macroscopic and microscopic descriptions of the disease process are given for selected organs.
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Affiliation(s)
- E A Sheffield
- Department of Pathology, Bristol Royal Infirmary, United Kingdom
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Blinder D, Yahatom R, Taicher S. Oral manifestations of sarcoidosis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 83:458-61. [PMID: 9127377 DOI: 10.1016/s1079-2104(97)90145-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To report two new cases of sarcoidosis of the buccal mucosa and to analyze the literature on oral manifestations of sarcoidosis. STUDY DESIGN Oral lesions with histologic features of sarcoidosis were analyzed according to their location and appearance. RESULTS Analysis of 45 cases of oral sarcoidosis (43 from the literature and the 2 new presented cases) revealed 12 lesions in the jaws, 10 in the buccal mucosa, 6 in the gingiva, 5 in the lips, 5 in the floor of the mouth, 4 in the tongue, and 3 in the palate. Sarcoidosis in the jaw was located in the alveolar bone and presented as an ill-defined radiolucency. Submucosal nodules were observed in sarcoidosis affecting the buccal mucosa, palate, and lip. Swelling was the main manifestation in the gingiva. In the floor of the mouth, sarcoidosis presented as ranula and that of the tongue as induration. In most of the cases, the lesions in the buccal mucosa, gingiva, and tongue were the first clinical manifestation of the disease. CONCLUSION Oral sarcoidosis lesions should be considered in the differential diagnosis of oral soft tissue swellings and jaw lesions.
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Affiliation(s)
- D Blinder
- Department of oral and Maxillofacial Surgery, Sheba Medical Center, Tel Hashomer
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36
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Shah UK, White JA, Gooey JE, Hybels RL. Otolaryngologic manifestations of sarcoidosis: presentation and diagnosis. Laryngoscope 1997; 107:67-75. [PMID: 9001268 DOI: 10.1097/00005537-199701000-00015] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Neuro-otologic manifestations of sarcoidosis are rare. Dizziness in particular is a rare presenting complaint of the patient afflicted with this systemic granulomatous disorder. Head and neck and sinonasal presentations of this disease are more common. We reviewed our experience with six such patients who presented for management of their otolaryngologic (ORL) manifestations in order to delineate the involvement of the otolaryngologist in the treatment and diagnosis of these patients, with a focus upon the relevant tests and procedures in the otolaryngologist's de novo diagnosis of sarcoidosis. Studies ordered in the course of otolaryngologic evaluation and their utility in the diagnosis of sarcoidosis by the otolaryngologist are reviewed and classified into useful, supportive, and ancillary. The otolaryngologist played an important role in diagnosis, with four of six patients diagnosed to have sarcoidosis on the basis of their otolaryngologic presentations. Biopsy was performed by the otolaryngologist for diagnosis of sarcoidosis in all four of these cases. Steroids were central to treatment. Oral steroid therapy was the principal treatment: both patients with neuro-otologic sarcoid were successfully managed with oral steroids. Intralesional steroids were necessary to treat the skin lesion. One of six patients patients experienced complications related to steroid use.
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Affiliation(s)
- U K Shah
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA, USA
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37
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Michon-Pasturel U, Hachulla E, Bloget F, Labalette P, Hatron PY, Devulder B, Janin A. [Role of biopsy of the accessory salivary glands in Löfgren's syndrome and other forms of sarcoidosis]. Rev Med Interne 1996; 17:452-5. [PMID: 8758530 DOI: 10.1016/0248-8663(96)86436-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The diagnosis of sarcoidosis requires histopathological analysis. Easy accessible site of biopsy is seldom. A systematic labial salivary gland biopsy was performed in 62 suspected sarcoidosis: 22 patients with Löfgren syndrome (group I), and 40 patients with systemic sarcoidosis (group II). Systematic bronchial biopsy was performed in eight patients of group I and ten patients of group II. If systematic biopsies were negative, direct biopsies were performed (lymph node, skin, kidney, liver). In group I, 8/22 labial salivary gland biopsies and 1/8 bronchial biopsies were positive; in group II, 17/40 labial salivary gland biopsies and 5/10 bronchial biopsies were positive. In the other patients, direct biopsies were positive: 27 lymph nodes, eight skin, eight hepatic, four kidney biopsies. In conclusion, labial salivary gland biopsy (even in the absence of sicca syndrome) is more reliable than systematic bronchial biopsies, particularly in Löfgren syndrome and may avoid in 30 to 50% of the cases more aggressive and dangerous biopsies such as liver, kidney or deep lymph nodes biopsies.
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Affiliation(s)
- U Michon-Pasturel
- Service de médecine interne, hôpital Claude-Huriez, CHRU, Lille, France
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Vijay V, Newman R, Bebawi MA, Godfrey HG. Sarcoid ranula. Its association with wide-spread sarcoidosis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 79:449-51. [PMID: 7614203 DOI: 10.1016/s1079-2104(05)80125-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The presence of noncaseating granulomas in salivary tissue is a specific feature of sarcoidosis. We document the case of a healthy woman who presented with a sarcoid ranula of the sublingual salivary gland without any other manifestations of the disease. This sarcoid ranula subsequently progressed to symptomatic widespread sarcoidosis in a span of 7 months. An asymptomatic sarcoid ranula may thus possibly represent a precursor to widespread sarcoidosis.
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Affiliation(s)
- V Vijay
- Mount Sinai School of Medicine, Program B, North General Hospital, New York, N.Y., USA
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Queiroga HJC. Tratamento da Sarcoidose**Actualização de conbecimentos apresentada à Faculdade de Medicina do Porto para satisfação da Prova Complementar de Doutoramento a que se refere a alinea b) do n.o 3 do arto 8 do Decreto-Lei n. o 308/70 de 18 de Agosto. REVISTA PORTUGUESA DE PNEUMOLOGIA 1995. [DOI: 10.1016/s0873-2159(15)31202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mandel L, Kaynar A. Sialadenopathy: a clinical herald of sarcoidosis: report of two cases. J Oral Maxillofac Surg 1994; 52:1208-10. [PMID: 7965320 DOI: 10.1016/0278-2391(94)90549-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- L Mandel
- Salivary Gland Center, Columbia University School of Dental and Oral Surgery, New York, NY 10032
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Beck AD, Newman NJ, Grossniklaus HE, Galetta SL, Kramer TR. Optic nerve enlargement and chronic visual loss. Surv Ophthalmol 1994; 38:555-66. [PMID: 8066544 DOI: 10.1016/0039-6257(94)90148-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We present four patients with sarcoidosis of the anterior visual pathways. The first patient presented with unilateral visual loss, a mass lesion at the optic nerve head, and an enlarged orbital optic nerve. The second patient presented with bilateral progressive painless visual loss, associated with optic nerve pallor and visual field loss. In these two patients, optic nerve biopsy was diagnostic of sarcoidosis. The third patient developed optic nerve and chiasmal involvement after sarcoidosis was established by lacrimal gland biopsy. The fourth patient had optic nerve, pulmonary, and lymph node involvement with sarcoidosis. A conjunctival and lung biopsy were diagnostic. Computed tomography and magnetic resonance imaging have greatly facilitated diagnosis of sarcoidosis of the anterior visual pathways. Sarcoidosis of the anterior visual pathways may occur alone or in association with other ocular or systemic manifestations. A conjunctival or lacrimal gland biopsy may be preferable as the initial diagnostic approach. Treatment of patients with this condition may require systemic immunosuppression, in addition to corticosteroids, to prevent permanent visual loss.
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Affiliation(s)
- A D Beck
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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42
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Weissler JC. Southwestern internal medicine conference: sarcoidosis: immunology and clinical management. Am J Med Sci 1994; 307:233-45. [PMID: 8160716 DOI: 10.1097/00000441-199403000-00012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sarcoidosis is a chronic inflammatory disease characterized by the presence of noncaseating granulomas in the lung and other organs. Current evidence suggests that this response is driven by a foreign antigen whose identity remains unclear. In this article, the nature of the cellular immune response is explored and the value of local markers of inflammation in predicting clinical course is examined.
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Affiliation(s)
- J C Weissler
- James M. Collins Center for Biomedical Research, University of Texas Southwestern Medical Center at Dallas 75235-9034
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43
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Abstract
Sarcoidosis is a chronic granulomatous disease of uncertain etiology. It can affect essentially every organ system in the human body and its manifestations are protean. Sarcoidosis can present in the emergency department (ED) as de novo disease, as preexisting disease with acute exacerbations, or as chronic debilitation. The authors provide a review of the various manifestations of this disease with emphasis on ED presentation and evaluation.
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Affiliation(s)
- C V Pollack
- Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona
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44
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Mattingly GK, Rodu B. Pathology Update. Oral Maxillofac Surg Clin North Am 1993. [DOI: 10.1016/s1042-3699(20)30663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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45
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46
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Isdale AH. Renal cell carcinoma with acute monarthritis. Ann Rheum Dis 1992; 51:1182-3. [PMID: 1444640 PMCID: PMC1012438 DOI: 10.1136/ard.51.10.1182-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Granulomatous inflammation in salivary tissues is most often a response to liberated ductal contents, particularly mucin, in various degrees of obstructive sialadenopathy. Far less often is a granulomatous sialadenitis the result of specific infective granulomas or systemic granuloma-forming diseases. In these instances, the salivary parenchymal involvement is usually secondary to disease localization in regional lymph nodes.
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Affiliation(s)
- J G Batsakis
- University of Texas M. D. Anderson Cancer Center, Houston 77030
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48
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Koopmans PP, Bodeutsch C, de Wilde PC, Boerbooms AM. Primary Sjögren's syndrome presenting as a case of sarcoidosis and a suspected pancreatic tumour. Ann Rheum Dis 1990; 49:407-9. [PMID: 2383067 PMCID: PMC1004112 DOI: 10.1136/ard.49.6.407] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 45 year old man, previously diagnosed as having sarcoid, presented with signs and symptoms of a pancreatic malignancy. An explorative laparotomy, however, showed only chronic pancreatitis. He was found to have a raised erythrocyte sedimentation rate, normocytic normochromic anaemia, renal insufficiency, hypergammaglobulinaemia, and a strongly positive rheumatoid factor and antinuclear antibody titre. Bilateral hilar lymph node enlargement was noted on chest x ray. Subsequently, the patient complained of xerostomia and keratoconjunctivitis sicca. Large lymphocytic infiltrates and a shift in the relative number of IgA bearing plasma cells in favour of IgG and IgM bearing plasma cells were seen in tissue obtained by sublabial salivary gland biopsy. A transbronchial lung biopsy and review of the biopsies of the pancreas, the lung, liver, and a lymph node all failed to show granulomatous disease. These findings strongly suggested a diagnosis of Sjögren's syndrome instead of sarcoidosis. This case shows the difficulty sometimes encountered in differentiating between sarcoid and systemic Sjögren's syndrome, and the value of a sublabial salivary gland biopsy.
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Affiliation(s)
- P P Koopmans
- Department of Medicine, University Hospital, Nijmegen, The Netherlands
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49
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50
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Aggarwal AP, Jayaram G, Mandal AK. Sarcoidosis diagnosed on fine-needle aspiration cytology of salivary glands: a report of three cases. Diagn Cytopathol 1989; 5:289-92. [PMID: 2791835 DOI: 10.1002/dc.2840050312] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Three female patients, two presenting with bilateral parotid gland enlargement and one with bilateral submandibular gland enlargement, were subjected to fine-needle aspiration cytology (FNAC). Smears showed noncaseating epithelioid cell granulomas with or without giant cells and salivary gland acini with varying degrees of degenerative changes. After excluding other granulomatous lesions, sarcoidosis was suggested and was subsequently proved in all three cases. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with head and neck involvement.
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Affiliation(s)
- A P Aggarwal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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