1
|
Samalia PD, Lim LL, Niederer RL. Insights into the diagnosis and management of sarcoid uveitis: A review. Clin Exp Ophthalmol 2024; 52:294-316. [PMID: 38385625 DOI: 10.1111/ceo.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
Sarcoidosis is a leading cause of non-infectious uveitis that commonly affects middle-aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non-caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid-sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.
Collapse
Affiliation(s)
- Priya D Samalia
- Department of Opthalmology, Te Whatu Ora Southern, Dunedin, New Zealand
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lyndell L Lim
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Rachael L Niederer
- Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Bazewicz M, Makhoul D, Goffin L, El Mouden J, Judice M Relvas L, Caspers L, Draganova D, Postelmans L, Garcia C, Willermain F. Clinical Utility of 18F-FDG PET/CT in the Work-up of Children with Uveitis. Ocul Immunol Inflamm 2023; 31:77-86. [PMID: 35113746 DOI: 10.1080/09273948.2021.1985522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate 18F-fluorodeoxyglucose Positron Emission Tomography/ultra low dose Computed Tomography (18F-FDG PET/ ULD CT) in the work-up of pediatric uveitis. METHODS Retrospective study of 12 children followed for uveitis who underwent whole body 18F-FDG PET/ULD CT between 2011 and 2019. RESULTS The average age of the patients was 11 years. A total of 100% of patients presented with bilateral uveitis, 50% had panuveitis and 92% had various choroidal involvement. Relevant information for diagnosis was provided in four patients. 5/12 had an abnormal 18F-FDG uptake. Of these, three patients had pathognomonic images of active granulomatous diseases. Three patients underwent PET CT-guided biopsies of which two were positive for sarcoidosis. CONCLUSION 18F-FDG PET/CT provided important information for final diagnosis in approximately 30% (4/12) of pediatric patients with bilateral uveitis. Whole body FDG PET/ULD CT can contribute to the final diagnosis thanks to pathognomonic image of active granulomatous disease and/or by indicating metabolically active site of biopsy that would not be visualized in thorax CT.
Collapse
Affiliation(s)
- M Bazewicz
- Ophthalmology, CHU Saint Pierre and CHU Brugmann, Brussels, Belgium
| | - D Makhoul
- Ophthalmology, CHU Saint Pierre, Brussels, Belgium
| | - L Goffin
- Pediatry, Queen Fabiola Children's University Hospital, Brussels, Belgium
| | - J El Mouden
- Ophthalmology, CHU Brugmann, Brussels, Belgium
| | | | - L Caspers
- Ophthalmology, CHU Saint Pierre, Brussels, Belgium
| | - D Draganova
- Ophthalmology, CHU Saint Pierre and CHU Brugmann, Brussels, Belgium
| | | | - C Garcia
- Nuclear Medicine, CHU Saint Pierre, Université Libre De Bruxelles, Brussels, Belgium
| | - F Willermain
- Ophthalmology, CHU Saint-Pierre and CHU Brugmann, Université Libre De Bruxelles, Brussels, Belgium
| |
Collapse
|
3
|
Sarcoid Uveitis: An Intriguing Challenger. Medicina (B Aires) 2022; 58:medicina58070898. [PMID: 35888617 PMCID: PMC9316395 DOI: 10.3390/medicina58070898] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of our work is to describe the actual knowledge concerning etiopathogenesis, clinical manifestations, diagnostic procedures, complications and therapy of ocular sarcoidosis (OS). The study is based on a recent literature review and on the experience of our tertiary referral center. Data were retrospectively analyzed from the electronic medical records of 235 patients (461 eyes) suffering from a biopsy-proven ocular sarcoidosis. Middle-aged females presenting bilateral ocular involvement are mainly affected; eye involvement at onset is present in one-third of subjects. Uveitis subtype presentation ranges widely among different studies: panuveitis and multiple chorioretinal granulomas, retinal segmental vasculitis, intermediate uveitis and vitreitis, anterior uveitis with granulomatous mutton-fat keratic precipitates, iris nodules, and synechiae are the main ocular features. The most important complications are cataract, glaucoma, cystoid macular edema (CME), and epiretinal membrane. Therapy is based on the disease localization and the severity of systemic or ocular involvement. Local, intravitreal, or systemic steroids are the mainstay of treatment; refractory or partially responsive disease has to be treated with conventional and biologic immunosuppressants. In conclusion, we summarize the current knowledge and assessment of ophthalmological inflammatory manifestations (mainly uveitis) of OS, which permit an early diagnostic assay and a prompt treatment.
Collapse
|
4
|
Keijsers RG, Grutters JC. In Which Patients with Sarcoidosis Is FDG PET/CT Indicated? J Clin Med 2020; 9:E890. [PMID: 32213991 PMCID: PMC7141490 DOI: 10.3390/jcm9030890] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of which the etiology remains unknown. The diverse clinical manifestations may challenge clinicians, particularly when conventional markers are inconclusive. From various studies, it has become clear that fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT aids in sarcoidosis care. In this article, an update on FDG PET/CT in sarcoidosis is provided. The use of FDG PET/CT in the diagnostic process of sarcoidosis is explained, especially in determining treatable inflammatory lesions in symptomatic patients with indecisive conventional tests. Furthermore, FDG PET/CT for evaluating the potential benefit of additional inflammatory treatment is described and its use in cardiac sarcoidosis is highlighted.
Collapse
Affiliation(s)
- Ruth G.M. Keijsers
- Department of Nuclear Medicine, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Jan C. Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands;
- Division of Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
5
|
Burger C, Holness JL, Smit DP, Griffith-Richards S, Koegelenberg CFN, Ellmann A. The Role of 18F-FDG PET/CT in Suspected Intraocular Sarcoidosis and Tuberculosis. Ocul Immunol Inflamm 2019; 29:530-536. [PMID: 31743044 DOI: 10.1080/09273948.2019.1685109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To determine the utility of fluorine-18 fluorodeoxyglucose Positron Emission Tomography Computed Tomography (FDG PET/CT) in patients with suspected ocular sarcoidosis (OS) or intraocular tuberculosis (IOTB) in a resource-constrained, TB endemic area.Methods: Independent review of the FDG PET/CTs, Computed Tomography (CT) scans and chest radiographs (CXRs) of patients with suspected OS or IOTB and inconclusive conventional workup.Results: Twenty-nine PET/CTs and CXRs were reviewed, with 38% of PET/CTs and CTs demonstrating evidence of TB or sarcoidosis, compared to 21% of CXRs. The sensitivity, specificity, positive and negative predictive values for PET/CT and CT were similar - 85.7%, 95.5%, 85.7% and 95.5% for OS, and 33.3%, 100%, 100% and 68% for IOTB respectively and for CXR, 57.1%, 100%, 100% and 88% for OS, and 16.7%, 100%, 100% and 63% for IOTB.Conclusion: PET/CT added no significant additional benefit over Chest CT in patients with suspected OS or IOTB.
Collapse
Affiliation(s)
- C Burger
- Divisions of Nuclear Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - J L Holness
- Divisions of Nuclear Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - D P Smit
- Ophthalmology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - S Griffith-Richards
- Radiodiagnosis, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - C F N Koegelenberg
- Pulmonology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - A Ellmann
- Divisions of Nuclear Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
6
|
Grumet P, Kerever S, Gilbert T, Kodjikian L, Gerfaud-Valentin M, De Parisot A, Jamilloux Y, Sève P. Clinical and etiologic characteristics of de novo uveitis in patients aged 60 years and above: experience of a French tertiary center. Graefes Arch Clin Exp Ophthalmol 2019; 257:1971-1979. [PMID: 31312906 DOI: 10.1007/s00417-019-04411-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/05/2019] [Accepted: 07/02/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To describe the characteristics of de novo uveitis in patients ≥ 60 years old. METHODS Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared. RESULTS A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group. CONCLUSION In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.
Collapse
Affiliation(s)
- P Grumet
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - S Kerever
- Service d'Anesthésie-Réanimation, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Gilbert
- Service de Gériatrie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - L Kodjikian
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - M Gerfaud-Valentin
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - A De Parisot
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - Y Jamilloux
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - P Sève
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France. .,Hospices Civils de Lyon, Pôle IMER, F-69003, Lyon, France. .,Univ. Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
| |
Collapse
|
7
|
Chauvelot P, Skanjeti A, Jamilloux Y, de Parisot A, Broussolle C, Denis P, Ramackers JM, Giammarile F, Kodjikian L, Seve P. 18F-fluorodeoxyglucose positron emission tomography is useful for the diagnosis of intraocular sarcoidosis in patients with a normal CT scan. Br J Ophthalmol 2019; 103:1650-1655. [PMID: 30658987 DOI: 10.1136/bjophthalmol-2018-313133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/05/2018] [Accepted: 12/19/2018] [Indexed: 11/04/2022]
Abstract
AIM To assess the usefulness of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) and the predictive factors for the diagnosis of sarcoidosis in patients with uveitis who have normal thoracic tomography. METHODS We retrospectively reviewed 67 consecutive patients with uveitis of unknown aetiology or a suspected sarcoidosis. All patients with normal thoracic tomography underwent an 18F-FDG PET/CT, which was blindly reinterpreted. We then assessed the proportion of positive 18F-FDG PET/CT and the impact on the final aetiology, using Abad's criteria for the diagnosis of intraocular sarcoidosis. RESULTS 19 of the 67 patients (28.4%) had mediastinal hypermetabolic foci on their 18F-FDG PET/CT consistent with sarcoidosis. It identified a biopsy site in two cases, which were consistent with sarcoidosis. At the end of the study, six patients (10%) had a proven sarcoidosis, six patients (9%) were considered as having a presumed sarcoidosis and 18 patients (26.9%) as having indeterminate sarcoidosis. 18F-FDG PET/CT enabled the diagnosis of presumed sarcoidosis in these six patients. An older age at diagnosis (p=0.004) and the presence of synechiae (p=0.02) were significantly related to an abnormal 18F-FDG PET/CT, with a trend for an elevated ACE (p=0.0993). We established a nomogram to estimate the probability of having positive findings on the 18F-FDG PET/CT according to different predictive factors. CONCLUSION 18F-FDG PET/CT enabled the diagnosis of intraocular sarcoidosis even in patients with a normal CT scan. Older age at diagnosis, presence of synechiae and elevated ACE are associated with positive findings on 18F-FDG PET/CT consistent with sarcoidosis.
Collapse
Affiliation(s)
- Pierre Chauvelot
- Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Andrea Skanjeti
- Service de Médecine Nucléaire, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Yvan Jamilloux
- Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Audrey de Parisot
- Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Christiane Broussolle
- Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe Denis
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jean Marie Ramackers
- Service de Médecine Nucléaire, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Francesco Giammarile
- Service de Médecine Nucléaire, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pascal Seve
- Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
8
|
Sève P, Kodjikian L, Jamilloux Y. Manifestations ophtalmologiques de la sarcoïdose : que doit savoir l’interniste ? Rev Med Interne 2018; 39:728-737. [DOI: 10.1016/j.revmed.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/21/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
|
9
|
Kluger N. Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature. J Eur Acad Dermatol Venereol 2018; 32:1852-1861. [DOI: 10.1111/jdv.15070] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/30/2018] [Indexed: 12/15/2022]
Affiliation(s)
- N. Kluger
- Departments of Dermatology, Allergology and Venereology Helsinki University Central Hospital, University of Helsinki Helsinki Finland
- ⪡Tattoo⪢ Consultation Department of Dermatology Bichat‐Claude Bernard Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| |
Collapse
|
10
|
Grumet P, Kodjikian L, de Parisot A, Errera MH, Sedira N, Heron E, Pérard L, Cornut PL, Schneider C, Rivière S, Ollé P, Pugnet G, Cathébras P, Manoli P, Bodaghi B, Saadoun D, Baillif S, Tieulie N, Andre M, Chiambaretta F, Bonin N, Bielefeld P, Bron A, Mouriaux F, Bienvenu B, Vicente S, Bin S, Labetoulle M, Broussolle C, Jamilloux Y, Decullier E, Sève P. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis). Autoimmun Rev 2018; 17:331-343. [DOI: 10.1016/j.autrev.2017.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/19/2022]
|
11
|
de Parisot A, Kodjikian L, Errera MH, Sedira N, Heron E, Pérard L, Cornut PL, Schneider C, Rivière S, Ollé P, Pugnet G, Cathébras P, Manoli P, Bodaghi B, Saadoun D, Baillif S, Tieulie N, Andre M, Chiambaretta F, Bonin N, Bielefeld P, Bron A, Mouriaux F, Bienvenu B, Vicente S, Bin S, Broussolle C, Decullier E, Sève P. Randomized Controlled Trial Evaluating a Standardized Strategy for Uveitis Etiologic Diagnosis (ULISSE). Am J Ophthalmol 2017; 178:176-185. [PMID: 28366648 DOI: 10.1016/j.ajo.2017.03.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To prospectively assess the efficiency of a standardized diagnostic approach, compared to an open strategy, for the etiologic diagnosis of uveitis. DESIGN Noninferiority, prospective, multicenter, clustered randomized controlled trial. METHODS Consecutive patients with uveitis, who visited 1 of the participating departments of ophthalmology, were included. In the standardized group, all patients had a minimal evaluation regardless of the type of uveitis (complete blood count, erythrocyte sedimentation rate, C-reactive protein, tuberculin skin test, syphilis serology, and chest radiograph) followed by more complex investigations according to ophthalmologic findings. In the open group, the ophthalmologist could order any type of investigation. Main outcome was the percentage of etiologic diagnoses at 6 months. RESULTS Nine hundred and three patients with uveitis were included from January 2010 to May 2013 and the per-protocol population comprised 676 patients (open 373; standardized 303). Mean age at diagnosis was 46 years. Anatomic distribution of uveitis was as follows: anterior (60.8% and 72.3%, P = .0017), intermediate (11.7% and 12.3%, P = .8028), posterior (17.8% and 8.2%, P = .0004), and panuveitis (15.3% and 15.2%, P = .9596). An etiologic diagnosis was established in 54.4% of cases in the open group and 49.5% in the standardized group (P = .2029). The difference between both strategies (standardized minus open) was -4.9% (95% CI [-12.5%; 2.6%]). There were more investigations in the open group than in the standardized group (5371 vs 3759, P < .0001). CONCLUSION The standardized strategy appears to be an efficient diagnostic approach for the etiologic diagnosis of uveitis, although its noninferiority cannot be proved.
Collapse
|
12
|
Jones NP, Tsierkezou L, Patton N. Lymphopenia as a predictor of sarcoidosis in patients with uveitis. Br J Ophthalmol 2016; 100:1393-6. [DOI: 10.1136/bjophthalmol-2015-307455] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/02/2015] [Indexed: 02/03/2023]
|
13
|
[Management of uveomeningitis in internal medicine: Proposal for a diagnostic work-up]. Rev Med Interne 2015; 37:25-34. [PMID: 26541836 DOI: 10.1016/j.revmed.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 09/26/2015] [Indexed: 01/14/2023]
Abstract
Uveomeningitis relates to an inflammatory state extending from iris and ciliary bodies to the choroid behind the eye. Because of a close contact between eye and brain, and barrier disruption, the inflammation can spread into the central nervous system (CNS). We review the clinical manifestations of uveitis, which are known to provide helpful clues to the diagnosis and describe the infectious, inflammatory, and neoplastic conditions classically associated with the uveomeningitis. Inflammatory or auto-immune diseases are probably the most common clinically recognized causes of uveomeningitis associated with a significant pleiocytosis. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (i.e., sarcoidosis, Behçet's disease, and Vogt-Koyanagi-Harada syndrome). The association of an infectious uveitis with an acute or a chronic meningo-encephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for an uveomeningitis. One should consider the diagnosis of primary ocular-CNS lymphoma in patients of 40 years of age or older with bilateral uveitis, especially with prominent vitritis, showing poor response to corticosteroid therapy. Finally, an algorithm for the diagnostic approach of uveomeningitis is proposed.
Collapse
|
14
|
Le Reun S, Poulain M, Perlat A, Mortemousque B. Apport du TEP-scan dans le diagnostic positif de la sarcoïdose, au cours du bilan d’uvéite indéterminée. J Fr Ophtalmol 2015; 38:103-11. [DOI: 10.1016/j.jfo.2014.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/11/2014] [Accepted: 09/17/2014] [Indexed: 11/30/2022]
|
15
|
Brackers de Hugo L, Ffrench M, Broussolle C, Sève P. Granulomatous lesions in bone marrow: clinicopathologic findings and significance in a study of 48 cases. Eur J Intern Med 2013; 24:468-73. [PMID: 23414770 DOI: 10.1016/j.ejim.2012.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Granulomas in bone marrow are an infrequent finding related to various disorders. The aim of this study was to review our clinical experience with granulomatous bone marrow disease and to describe the contributions of recent diagnostic tools, such as (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and molecular biology. METHODS Clinical, laboratory and morphological data on patients with a granuloma based on bone marrow biopsy analysed in the University Hospital Lyon from May 2004 to July 2010 were reviewed. RESULTS We identified 57 cases among 9641 bone marrow biopsies, representing an incidence of 0.59% in the series and an annual incidence of 9.5 cases per year. Nine biopsies performed for staging a known pathology were excluded from further analysis. Among the 48 remaining patients, associated disease was demonstrated in 79%, with infections being the most common (33%), following by sarcoidosis (21%), malignancy (19%) and therapy-induced granulomas (6%). One previously unpublished entity is described: infection with Bartonella henselae diagnosed using molecular biology from node and skin biopsies in two renal transplant patients. (18)F-FDG-PET, performed in 13 cases, showed hypermetabolic foci consistent with sarcoidosis in two cases. Positive PCR result for an infectious pathogen was obtained in three bone marrow samples (Mycobacterium tuberculosis, n=1; Mycobacterium genavense, n=2). CONCLUSION In comparison to previous research, our study reports high proportions of cases caused by sarcoidosis and unknown causes. (18)F-FDG-PET could show signs consistent with sarcoidosis and molecular biology is useful for the detection of fastidious bacteria in immunocompromised patients.
Collapse
|
16
|
Jadcherla SR, Chan CY, Moore R, Fernandez S, Shaker R. Physiology of esophageal sensorimotor malfunctions in neonatal neurological illness. Am J Physiol Gastrointest Liver Physiol 2013; 304:G574-82. [PMID: 23328206 PMCID: PMC3602684 DOI: 10.1152/ajpgi.00404.2012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We aimed to define the sensorimotor characteristics of aero-digestive reflexes evoked upon midesophageal provocations in neuropathology infants. Provocative esophageal motility testing was performed in 20 neuropathology infants and 10 controls at 42.3 ± 0.6 and 38.9 ± 0.9 wk postmenstrual age. Data from 1,073 infusions were examined for the sensory thresholds, response frequencies, response magnitude of upper esophageal sphincter (UES) contractile reflexes, lower esophageal sphincter (LES) relaxation reflexes, and peristaltic reflexes using mixed statistical models. Threshold volumes for air and liquid in neuropathology and control infants were similar for all reflexes. Graded air- and liquid volume-dependent UES contractile reflex, LES relaxation reflex, and peristaltic reflex frequency recruitment were present in neuropathology and control subjects for the media (P < 0.0001) and the reflexes (P < 0.0001). In neuropathology infants (vs. controls), UES contractile magnitude is higher (P < 0.0001); LES relaxation reflex occurred earlier (P = 0.008); LES nadir duration lasted longer (P = 0.006); secondary peristalsis is the chief method of esophageal clearance (P < 0.0001); pharyngeal swallows and deglutition apneas are less frequent (P = 0.001); proximal, midesophageal waveform magnitudes and duration are exaggerated (P < 0.008). UES contractile reflex was longer with liquid than air in both groups (P = 0.03). We concluded that 1) perception to midesophageal provocation remains preserved in neuropathology neonates; 2) sustained and exaggerated myogenic response from afferent activation is evident by increased excitatory efferent outputs to the UES and esophageal body and increased inhibitory efferent outputs to the LES; 3) dysfunctional regulation of pharyngeal swallowing and infrequent deglutition responses indicate the possibility of impaired descending modulation and central malfunctions of brainstem and vagal nuclei.
Collapse
Affiliation(s)
- Sudarshan R. Jadcherla
- 1Sections of Neonatology, Pediatric Gastroenterology and Nutrition, ,2The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Department of Pediatrics, and
| | - Chin Yee Chan
- 2The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Department of Pediatrics, and
| | - Rebecca Moore
- 2The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Department of Pediatrics, and
| | - Soledad Fernandez
- 3Center for Biostatistics, The Ohio State University College of Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio;
| | - Reza Shaker
- 4Division of Gastroenterology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
17
|
Pruna L, Angioi K, Robin A, Deibener J, Poirson A, Selton J, Mohamed S, Kaminsky P. Uvéites révélant une sarcoïdose : caractéristiques cliniques à propos de 23 cas. Rev Med Interne 2012; 33:615-20. [DOI: 10.1016/j.revmed.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/10/2012] [Accepted: 06/02/2012] [Indexed: 11/29/2022]
|
18
|
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
|
19
|
Abstract
Sarcoidosis as a distinct disease entity was diagnosed more than 100 years ago. The signs and symptoms of the disease are nonspecific, posing a challenge for early and accurate diagnosis. IgG4 disease or syndrome has various clinical manifestations, such as sclerosing pancreatitis, sclerosing cholangitis, prostatitis, tubulointerstitial nephritis, interstitial pneumonia, and enlargement of salivary glands. This article discusses the role of the different diagnostic imaging modalities in sarcoidosis and IgG4 disease, including radiographs, computed tomography, magnetic resonance imaging, and conventional nuclear medicine, with a special emphasis on positron emission tomography as a superior modality for assessing these inflammatory diseases.
Collapse
|
20
|
Grégoire MA, Kodjikian L, Varron L, Grange JD, Broussolle C, Seve P. Characteristics of Uveitis Presenting for the First Time in the Elderly: Analysis of 91 Patients in a Tertiary Center. Ocul Immunol Inflamm 2011; 19:219-26. [DOI: 10.3109/09273948.2011.580071] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
21
|
Hooper C, Pavesio C. Investigations in the diagnosis of uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.29] [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: 11/08/2022]
|
22
|
Marie I, François A, Janvresse A, Levesque H. Sarcoïdose testiculaire. Presse Med 2011; 40:545-7. [DOI: 10.1016/j.lpm.2010.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 10/24/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022] Open
|
23
|
Doycheva D, Pfannenberg C, Hetzel J, Deuter CME, Pavesio C, Kempf VAJ, Schuelen E, Aschoff P, Rao N, Zierhut M. Presumed tuberculosis-induced retinal vasculitis, diagnosed with positron emission tomography (18F-FDG-PET/CT), aspiration biopsy, and culture. Ocul Immunol Inflamm 2011; 18:194-9. [PMID: 20482398 DOI: 10.3109/09273948.2010.483318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The diagnosis of tuberculosis as an etiological factor in patients with uveitis is difficult because of lack of specific diagnostic tests. The authors report 2 cases of occlusive retinal vasculitis, in which (18)F-FDG-PET/CT was helpful for the diagnosis of tuberculosis as a presumptive cause of intraocular inflammation. METHODS In 2 patients with severe occlusive retinal vasculitis and positive QuantiFERON TB-Gold test, (18)F-FDG-PET/CT, transbronchial needle-aspiration biopsy, and microbiological investigation were performed. RESULTS (18)F-FDG-PET/CT showed increased fluorodeoxyglucose uptake in some mediastinal and hilar lymph nodes. After needle-aspiration biopsy of PET-positive lymph nodes, M. tuberculosis was recovered in culture in both cases. Remission of uveitis was achieved only after a combination therapy with 3 anti-tubercular agents and systemic steroids. CONCLUSION The authors favor the use of (18)F-FDG-PET/CT in patients with sight-threatening intraocular inflammation and positive interferon-gamma release assay. Anti-tubercular therapy, together with anti-inflammatory treatment, may lead to a remission in such patients.
Collapse
Affiliation(s)
- Deshka Doycheva
- Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Uvéites sarcoïdosiques : actualités diagnostiques et thérapeutiques. Rev Med Interne 2011; 32:86-92. [PMID: 20970226 DOI: 10.1016/j.revmed.2010.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 07/26/2010] [Accepted: 09/20/2010] [Indexed: 12/23/2022]
|
25
|
Sarcoïdose : quoi de neuf pour l’interniste en 2010 ? Rev Med Interne 2011; 32:71-2. [DOI: 10.1016/j.revmed.2010.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 09/15/2010] [Indexed: 10/18/2022]
|
26
|
Nguyen AM, Sève P, Le Scanff J, Gambrelle J, Fleury J, Broussolle C, Grange JD, Kodjikian L. Aspects cliniques et étiologiques des uvéites : étude rétrospective de 121 patients adressés à un centre tertiaire d’ophtalmologie. Rev Med Interne 2011; 32:9-16. [DOI: 10.1016/j.revmed.2010.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 06/18/2010] [Accepted: 07/30/2010] [Indexed: 10/19/2022]
|