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Medina-Felix D, Vargas-Albores F, Garibay-Valdez E, Martínez-Córdova LR, Martínez-Porchas M. Gastrointestinal dysbiosis induced by Nocardia sp. infection in tilapia. Comp Biochem Physiol Part D Genomics Proteomics 2024; 49:101154. [PMID: 37976964 DOI: 10.1016/j.cbd.2023.101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Nocardiosis has caused high mortalities among fish cultures; however, the effects of Nocardia infections in the fish gastrointestinal microbiota are unknown. In this research, tilapia was infected with Nocardia sp., to analyze the effect of infection on the gastrointestinal microbiota. Tilapia infected with Nocardia sp. reported a 46 % survival (100 % in non-infected). Moreover, the infection caused severe damage to the stomach microbiota, with a loss of diversity and a significant increase of Proteobacteria (94.8 %), resulting in a negative correlation network between Proteobacteria and other important phyla. Nocardia sp. is an emerging pathogen capable of inducing dysbiosis and causing significant mortalities.
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Affiliation(s)
| | - Francisco Vargas-Albores
- Centro de Investigación en Alimentación y Desarrollo, A.C. Biology of Aquatic Organisms, Hermosillo, Sonora, Mexico
| | - Estefanía Garibay-Valdez
- Centro de Investigación en Alimentación y Desarrollo, A.C. Biology of Aquatic Organisms, Hermosillo, Sonora, Mexico
| | - Luis Rafael Martínez-Córdova
- Universidad de Sonora, Departamento de Investigaciones Científicas y Tecnológicas de la Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Marcel Martínez-Porchas
- Centro de Investigación en Alimentación y Desarrollo, A.C. Biology of Aquatic Organisms, Hermosillo, Sonora, Mexico.
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Liu M, Chen H, Xu F. Dermoscopy of cutaneous sarcoidosis: a cross-sectional study. An Bras Dermatol 2023; 98:750-754. [PMID: 37487766 PMCID: PMC10589496 DOI: 10.1016/j.abd.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Although traditionally used for the diagnosis of skin tumors, in the past few years dermoscopy as a clinical diagnostic aid for inflammatory and infectious skin manifestations has also received more and more attention. The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Dermoscopy can be used as an auxiliary examination method. OBJECTIVE Our aim was to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of CS. METHODS This was a retrospective analysis of 39 CS clinical and dermoscopic images collected in the Department of Dermatology, Huashan Hospital Affiliated with Fudan University from August 2013 to February 2021. RESULTS Retrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures in all 39 cases. Variable diameter linear vessels were found in 38 cases. A central scar-like area was seen in 26 cases. Bright white streaks were seen in 30 cases. The follicular plugs were seen in 15 cases. STUDY LIMITATIONS First, the number of cutaneous sarcoidosis cases the authors collected is small. Second, due to the lack of a control group, the sensitivity and specificity of the proposed criteria were not calculated. Finally, since our study mainly includes suspicious lesions that were biopsied for diagnostic purposes, there may be a selection bias. CONCLUSION Lesions showing on dermoscopy grouped translucent orange ovoid structures associated with linear vessels should raise the suspicion of CS. Central scar-like areas and bright white streaks are also helpful in the diagnosis of CS.
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Affiliation(s)
- Mengguo Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huyan Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
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3
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Khongsit AK, Kumar S, Gupta B, Kumar S. An unusual case of oral sarcoidosis: A diagnostic dilemma. J Oral Maxillofac Pathol 2023; 27:607. [PMID: 38033961 PMCID: PMC10683891 DOI: 10.4103/jomfp.jomfp_552_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/14/2023] [Accepted: 03/06/2023] [Indexed: 12/02/2023] Open
Abstract
Sarcoidosis is a rare type of multi-organ granulomatous disease. It is characterised by non-caseating necrotising granulomatous inflammation. The exact mechanism causing the disease is unknown due to its variation of manifestation in patients. The clinical presentation of this disease is protean, and often, patients remain asymptomatic throughout life. The most commonly affected organ by sarcoidosis is the lung accounting for up to 90% of all cases. Oral manifestation is a relatively rare presentation of sarcoidosis, and there are only a few cases reported till date. In this case report, the authors present a case of oral sarcoidosis of the retromolar trigone region.
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Affiliation(s)
- Anuradha Kar Khongsit
- Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - Shailesh Kumar
- Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - Brijnandan Gupta
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - Subodh Kumar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
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4
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Lim CC, Ghauth S, Liew YT, Bakar MZBA, Narayanan PAL. Isolated cervical lymph node sarcoidosis: a diagnostic challenge of a case report. Eur Arch Otorhinolaryngol 2023; 280:925-927. [PMID: 36592173 DOI: 10.1007/s00405-022-07808-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sarcoidosis is a granulomatous disorder involving multi-systemic organs. Patients invariably have lung involvement but some may have extrapulmonary disease. Rarely, cervical lymphadenopathy is the only sign without mediastinal or pulmonary abnormalities. CASE PRESENTATION We report a Malay male who complained of neck swelling exclusively. On imaging, multiple enlarged cervical lymph nodes deep to the sternocleidomastoid muscle were seen. An excision biopsy revealed non-caseating granulomas with epithelioid macrophages. Extensive investigations led to the diagnosis of isolated cervical lymph node sarcoidosis. CONCLUSIONS Sarcoidosis can present as cervical lymphadenopathy alone, without mediastinal or lung disease. The presence of epithelioid granulomas on histopathology warrants the exclusion of other granulomatous diseases. Isolated cervical lymph node sarcoidosis is only diagnosed in the presence of consistent clinical and radiological findings. In this case, close monitoring for systemic sarcoidosis is important as it can manifest later in life.
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Affiliation(s)
- Chee Chean Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Sakina Ghauth
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yew Toong Liew
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Zukiflee Bin Abu Bakar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Prepageran A L Narayanan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia
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5
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Nies JF, Krusche M. [Immunoglobulin-G4-related disease]. Z Rheumatol 2022; 81:549-557. [PMID: 35767095 DOI: 10.1007/s00393-022-01229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
Abstract
After years of confusion about apparently distinct clinical disease symptoms, the term IgG4-related disease (IgG4-RD) has been coined in 2001, uniting these fibroinflammatory clinical entities with a tendency for tumorous enlargement and tissue fibrosis. Over the past two decades, experimental and clinical studies could make astounding progress in the understanding of this elusive disease. By now, we have a reasonable idea of the pathophysiological mechanisms, which opens up new avenues for therapeutic approaches. It seems like a dense lymphoplasmacytic cell infiltrate, consisting of B‑cells, IgG4+ plasma cells, follicular T‑helper cells, CD4+ cytotoxic T‑cells and M2 macrophages induces a smoldering inflammatory reaction with a fibrogenic cytokine milieu. This stimulates fibroblasts to secrete extracellular matrix components, leading to the histopathologically characteristic storiform fibrosis and obliterative phlebitis. Macroscopically, this reaction results in diffuse organ swelling and tumorous lesions. The macroscopic and histological differentiation from conditions mimicking IgG4-RD can be challenging. This is especially true for granulomatous diseases, such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The situation is further complicated by the fact that ANCAs can be positive in IgG4-RD and, vice versa IgG4 antibodies can be elevated in numerous differential diagnoses, such as infections, AAV, sarcoidosis, and malignancies. This article provides an overview of the multifaceted clinical condition of IgG4-RD with respect to the pathophysiology, diagnostic steps and treatment. Furthermore, an overview of the differential diagnoses is discussed especially with respect to granulomatous diseases.
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Affiliation(s)
- Jasper F Nies
- III. Medizinische Klinik und Poliklinik für Nephrologie, Rheumatologie und Endokrinologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
| | - Martin Krusche
- III. Medizinische Klinik und Poliklinik für Nephrologie, Rheumatologie und Endokrinologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland.
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6
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Baverez C, Richard M, Gerfaud Valentin M, Jamilloux Y, Seve P, Aslangul E. [Acute dyspnea in a 49 year-old man]. Rev Med Interne 2022:S0248-8663(22)00455-6. [PMID: 35659778 DOI: 10.1016/j.revmed.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022]
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7
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Vílchez-Oya F, Meraz-Ostíz JA, Carrión-Barberà I, Gonzàlez-Farré M, Carrión JA, Salman-Monte TC. Multi-organ Involvement in Non-pulmonary Sarcoidosis. Reumatol Clin (Engl Ed) 2022; 18:309-311. [PMID: 35568444 DOI: 10.1016/j.reumae.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/31/2021] [Indexed: 06/15/2023]
Abstract
Isolated extrapulmonary involvement in sarcoidosis is uncommon and reported in 5-9% of systemic sarcoidosis, this constitutes a clinical challenge due to its extensive differential diagnosis. Extrapulmonary sarcoidosis affecting more than three organs is rarely reported and there are scarce literature data published on diagnosis, clinical course and management in those cases. We hereby discuss a case of a 41-year-old female with systemic non-pulmonary sarcoidosis affecting lacrimal gland, peripheral lymph nodes, parotid gland and the liver.
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Affiliation(s)
- Francisco Vílchez-Oya
- Department of Rheumatology. Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain.
| | | | - Irene Carrión-Barberà
- Department of Rheumatology. Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain
| | - Mònica Gonzàlez-Farré
- Department of Pathological Anatomy, Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain
| | - Jose Antonio Carrión
- Department of Gastroenterology, Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain
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8
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Sarkar S, Ahmed N, Akhtar S, Sinha R. A child with persistent low-grade fever, urinary frequency, and hypertension: Answers. Pediatr Nephrol 2021; 36:4043-4. [PMID: 34251492 DOI: 10.1007/s00467-021-05184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
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9
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Chatterjee T, Reddy YPS, Kandula M. Mycobacterium avium complex: An unusual cause of hypercalcemia. IDCases 2021; 26:e01317. [PMID: 34786338 PMCID: PMC8577481 DOI: 10.1016/j.idcr.2021.e01317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
Mycobacterium avium-complex (MAC) is an infectious granulomatous disease which is associated with hypercalcemia especially in immunocompromised patients. We present an unusual case of MAC infection in an immunocompetent patient presenting as hypercalcemia.A 76-year-old immunocompetent male was admitted for hypercalcemia of 12.6 mg/dl found on outpatient evaluation for fatigue. PTH level was low 8 pmol/L, Vitamin D 25hydroxy was 29 ng/ml, 1,25 dihydroxy vitamin D (1,25(OH)2 vitamin D) levels was low at 11 pg/ml, PTH related peptide was 1.1 pmol/L. Hypercalcemia resolved with intravenous hydration and bisphosphonate administration. CT chest identified a nodule with central cavity in the right upper lobe. Pathology from percutaneous biopsy of thenodule demonstrated granulomatous inflammation. AFB culture came positive for MAC. Patient was treated with Azithromycin, Rifabutin and Ethambutol for twelve months.Granulomatous diseases like MAC cause hypercalcemia via activation of macrophages which express extrarenal 1- alpha -hydroxylase. It converts vitamin D to its active form 1,25(OH)2 vitamin D causing its excess, leading to hypercalcemia. Interestingly, in our patient calcium level was elevated with appropriately low PTH but 1,25(OH)2 vitamin D level was also low. There are few reported cases of hypercalcemia in granulomatous disease with normal levels of 1,25(OH)2 vitamin D levels, and our case is the first one to have MAC associated hypercalcemia with low 1,25(OH)2 vitamin D levels, suggesting an alternative mechanism for hypercalcemia in these patients.
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Affiliation(s)
- Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Manasa Kandula
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
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10
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Leon M, Liotta R, Aryal S, Vangeertruyden P, Tintle S, Klassen-Fischer M, Holley A, Kelly W, Collen J. Atraumatic forearm swelling in a patient with poorly controlled asthma. Respir Med Case Rep 2021; 33:101454. [PMID: 34401293 PMCID: PMC8349057 DOI: 10.1016/j.rmcr.2021.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
We present a case of sarcoidosis presenting as unilateral forearm swelling. A 65-year-old male with a long history of asthma presented with unexplained left forearm and hand swelling. Over many years, chest imaging had been devoid of adenopathy or parenchymal findings suspicious for sarcoid, until after the extremity findings emerged. The patient was diagnosed based on subcutaneous, dermal and mediastinal lymph node histopathology. Sarcoid presenting with isolated extremity findings prior to more typical pulmonary manifestations is rare even for cutaneous or soft tissue sarcoid, highlighting the need to maintain a high index of suspicion for sarcoidosis.
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Affiliation(s)
- Matthew Leon
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert Liotta
- Thoracic Radiology, Uniformed Services of the Health Sciences, Bethesda, MD, USA
| | - Shambhu Aryal
- Advanced Lung Disease Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Peter Vangeertruyden
- Musculoskeletal Radiology, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Scott Tintle
- Hand Surgery, Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Aaron Holley
- Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - William Kelly
- Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jacob Collen
- Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Corresponding author. FAASM Associate Professor of Medicine Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road Bethesda, Maryland, 20814, USA.
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11
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Santos A, Desgranges F, Jovanovic M, Anichini A, Kritikos A, Dunet V, Brouland JP, Théaudin M, Pot C, Du Pasquier R, Pantazou V. Discussing Challenges in Diagnosis of Tuberculous Meningitis and Neurosarcoidosis. Can J Neurol Sci 2021;:1-7. [PMID: 34165067 DOI: 10.1017/cjn.2021.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Isolated chronic granulomatous meningitis remains a diagnostic challenge for the physician. Symptoms are often nonspecific and ancillary tests have low-sensitivity rates, which may delay targeted treatment and lead to increased morbidity and mortality. Here, we discuss the challenges in diagnosing and treating patients with chronic meningitis by reporting two cases of previously healthy patients who presented with granulomatous meningitis on brain biopsy.
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12
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Vílchez-Oya F, Meraz-Ostíz JA, Carrión-Barberà I, Gonzàlez-Farré M, Carrión JA, Salman-Monte TC. Multi-organ Involvement in Non-pulmonary Sarcoidosis. Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(21)00119-4. [PMID: 34006482 DOI: 10.1016/j.reuma.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
Isolated extrapulmonary involvement in sarcoidosis is uncommon and reported in 5-9% of systemic sarcoidosis, this constitutes a clinical challenge due to its extensive differential diagnosis. Extrapulmonary sarcoidosis affecting more than three organs is rarely reported and there are scarce literature data published on diagnosis, clinical course and management in those cases. We hereby discuss a case of a 41-year-old female with systemic non-pulmonary sarcoidosis affecting lacrimal gland, peripheral lymph nodes, parotid gland and the liver.
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Affiliation(s)
- Francisco Vílchez-Oya
- Department of Rheumatology. Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain.
| | | | - Irene Carrión-Barberà
- Department of Rheumatology. Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain
| | - Mònica Gonzàlez-Farré
- Department of Pathological Anatomy, Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain
| | - Jose Antonio Carrión
- Department of Gastroenterology, Consorci Parc de Salut MAR/Hospital del Mar, Barcelona, Spain
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13
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Mertz P, Jeannel J, Guffroy A, Lescuyer S, Korganow AS, Rondeau-Lutz M, Weber JC. Granulomatous manifestations associated with COVID19 infection: Is there a link between these two diseases? Autoimmun Rev 2021; 20:102824. [PMID: 33864942 PMCID: PMC8056977 DOI: 10.1016/j.autrev.2021.102824] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Philippe Mertz
- Internal Medicine department, Strasbourg University Hospital, Strasbourg, France.
| | - Juliette Jeannel
- Internal Medicine department, Strasbourg University Hospital, Strasbourg, France
| | - Aurélien Guffroy
- Clinical Immunology department, National Reference Center for Rare Autoimmune Diseases (RESO), ERN RITA, Strasbourg University Hospital, Strasbourg, France
| | - Sylvain Lescuyer
- Internal Medicine department, Strasbourg University Hospital, Strasbourg, France
| | - Anne Sophie Korganow
- Clinical Immunology department, National Reference Center for Rare Autoimmune Diseases (RESO), ERN RITA, Strasbourg University Hospital, Strasbourg, France
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14
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Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology that most frequently occurs in the lungs. However, cutaneous lesions are often the primary sign. Cutaneous sarcoidosis is difficult to treat, although different therapies have been applied. We herein report a case in which cutaneous sarcoidosis was treated with pulsed-dye laser (PDL) therapy along with oral administration of acitretin and hydroxychloroquine; no topical medications were applied. All patient details are de-identified. The treatment areas gradually improved after several courses of PDL therapy. This case illustrates that PDL therapy can serve as an auxiliary treatment for cutaneous sarcoidosis.
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Affiliation(s)
- Wenxin Dong
- Department of Medical Cosmetic Center, Shanghai Skin Disease Hospital, Shanghai, China
| | - Caixia Li
- Department of Medical Cosmetic Center, Shanghai Skin Disease Hospital, Shanghai, China
| | - Yu Shi
- Department of Medical Cosmetic Center, Shanghai Skin Disease Hospital, Shanghai, China
| | - Wei Zhang
- Department of Medical Cosmetic Center, Shanghai Skin Disease Hospital, Shanghai, China
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15
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Okazaki F, Wakiguchi H, Korenaga Y, Nakamura T, Yasudo H, Uchi S, Yanai R, Asano N, Hoshii Y, Tanabe T, Izawa K, Honda Y, Nishikomori R, Uchida K, Eishi Y, Ohga S, Hasegawa S. A novel mutation in early-onset sarcoidosis/Blau syndrome: an association with Propionibacterium acnes. Pediatr Rheumatol Online J 2021; 19:18. [PMID: 33602264 PMCID: PMC7890802 DOI: 10.1186/s12969-021-00505-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early-onset sarcoidosis (EOS) and Blau syndrome (BS) are systemic inflammatory granulomatous diseases without visible pulmonary involvement, and are distinguishable from their sporadic and familial forms. The diseases are characterized by a triad of skin rashes, symmetrical polyarthritis, and recurrent uveitis. The most common morbidity is ocular involvement, which is usually refractory to conventional treatment. A gain-of-function mutation in the nucleotide-binding oligomerization domain-containing protein 2 (NOD2) gene has been demonstrated in this disease; however, little is known about the relationship between the activation of NOD2 and the pathophysiology of EOS/BS. Here we describe EOS/BS with a novel mutation in the NOD2 gene, as well as detection of Propionibacterium acnes (P. acnes) in the granulomatous inflammation. CASE PRESENTATION An 8-year-old Japanese girl presented with refractory bilateral granulomatous panuveitis. Although no joint involvement was evident, she exhibited skin lesions on her legs; a skin biopsy revealed granulomatous dermatitis, and P. acnes was detected within the sarcoid granulomas by immunohistochemistry with P. acnes-specific monoclonal (PAB) antibody. Genetic analyses revealed that the patient had a NOD2 heterozygous D512V mutation that was novel and not present in either of her parents. The mutant NOD2 showed a similar activation pattern to EOS/BS, thus confirming her diagnosis. After starting oral prednisolone treatment, she experienced an anterior vitreous opacity relapse despite gradual prednisolone tapering; oral methotrexate was subsequently administered, and the patient responded positively. CONCLUSIONS We presented a case of EOS/BS with a novel D512V mutation in the NOD2 gene. In refractory granulomatous panuveitis cases without any joint involvement, EOS/BS should be considered as a differential diagnosis; genetic analyses would lead to a definite diagnosis. Moreover, this is the first report of P. acnes demonstrated in granulomas of EOS/BS. Since intracellular P. acnes activates nuclear factor-kappa B in a NOD2-dependent manner, we hypothesized that the mechanism of granuloma formation in EOS/BS may be the result of NOD2 activity in the presence of the ligand muramyl dipeptide, which is a component of P. acnes. These results indicate that recognition of P. acnes through mutant NOD2 is the etiology in this patient with EOS/BS.
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Affiliation(s)
- Fumiko Okazaki
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Hiroyuki Wakiguchi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505, Ube, Yamaguchi, Japan.
| | - Yuno Korenaga
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Tamaki Nakamura
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Hiroki Yasudo
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Shohei Uchi
- grid.268397.10000 0001 0660 7960Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ryoji Yanai
- grid.268397.10000 0001 0660 7960Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Nobuyuki Asano
- grid.268397.10000 0001 0660 7960Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshinobu Hoshii
- grid.268397.10000 0001 0660 7960Department of Diagnostic Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tsuyoshi Tanabe
- grid.268397.10000 0001 0660 7960Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazushi Izawa
- grid.258799.80000 0004 0372 2033Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Honda
- grid.258799.80000 0004 0372 2033Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuta Nishikomori
- grid.258799.80000 0004 0372 2033Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan ,grid.410781.b0000 0001 0706 0776Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Keisuke Uchida
- grid.265073.50000 0001 1014 9130Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yoshinobu Eishi
- grid.265073.50000 0001 1014 9130Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Shouichi Ohga
- grid.177174.30000 0001 2242 4849Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Shunji Hasegawa
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
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16
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Viallard JF, Lebail B, Begueret H, Fieschi C. [Common variable immunodeficiency disorders: Part 2. Updated clinical manifestations and therapeutic management]. Rev Med Interne 2021; 42:473-481. [PMID: 33516581 DOI: 10.1016/j.revmed.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/04/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Common variable immunodeficiency disorders (CVID) are the most common symptomatic primary antibody deficiency in adults with an estimated prevalence of 1/25,000. The most frequent clinical manifestations are upper respiratory tract infections (including pneumonia, bronchitis, and sinusitis) predominantly with Streptococcus pneumoniae or H. influenzae. However, CVID are complicated in 20 to 30 % of cases of non-infectious manifestations which have been well characterized in recent years. Several complications can be observed including autoimmune, lymphoproliferative, granulomatous or cancerous manifestations involving one or more organs. These complications, mostly antibody-mediated cytopenias, are correlated with a decrease in the number of circulating switched memory B cells. Replacement therapy with polyvalent gammaglobulins has greatly improved the prognosis of these patients but it remains poor in the presence of digestive complications (especially in the case of chronic enteropathy and/or porto-sinusoidal vascular disease), pulmonary complications (bronchiectasis and/or granulomatous lymphocytic interstitial lung disease) and when progression to lymphoma. Much progress is still to be made, in particular on the therapeutic management of non-infectious complications which should benefit in the future from targeted treatments based on knowledge of genetics and immunology.
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Affiliation(s)
- J F Viallard
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, CHU de Bordeaux, 5, avenue de Magellan, 33604 Pessac, France; Université de Bordeaux, Bordeaux, France.
| | - B Lebail
- Université de Bordeaux, Bordeaux, France; Service d'anatomopathologie, hôpital Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux, France
| | - H Begueret
- Service d'anatomopathologie, CHU Bordeaux, hôpital Haut-Lévêque, 5, avenue de Magellan, 33604 Pessac, France
| | - C Fieschi
- Département d'immunologie, université de Paris, AP-HP, France; INSERM U1126, centre Hayem, hôpital Saint-Louis, Paris, France
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17
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Abstract
Hypercalcemia as a result of ectopic 1, 25-dihydroxyvitamin D (1,25-(OH)2 D) production has been well-described in sarcoidosis and other granulomatous diseases. The 1-alpha-hydroxylase enzyme in activated macrophages is not subject to physiologic regulations, resulting in hypercalcemia with inappropriately normal or elevated 1,25-(OH) 2 D. Particle disease is the local inflammatory response provoked by an overwhelming production of wear debris from a failed joint prosthesis. Enhanced focal bone resorption in particle disease has been described due to local production of inflammatory cytokines. However, this process previously has not been reported to cause hypercalcemia. We describe a patient with hypercalcemia, low parathyroid hormone levels, and elevated 1,25-(OH)2 D whose failed prosthetic joint generated a large amount of inflammatory debris, forming a soft tissue mass with lymphadenopathy. Biopsy of the mass demonstrated activated macrophages and foreign body granuloma, resulting in unregulated production of 1,25-(OH)2 D and hypercalcemia. We present the first case of hypercalcemia associated with elevated 1,25-(OH)2 D in particle disease due to a failed prosthetic hip.
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Affiliation(s)
- J Zhang
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - D E Sellmeyer
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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18
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Sawahata M, Sakamoto N, Yamasawa H, Iijima Y, Kawata H, Yamaguchi T, Uchida K, Eishi Y, Bando M, Hagiwara K. Propionibacterium acnes-associated sarcoidosis complicated by acute bird-related hypersensitivity pneumonitis. BMC Pulm Med 2020; 20:288. [PMID: 33160347 PMCID: PMC7649005 DOI: 10.1186/s12890-020-01327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/28/2020] [Indexed: 01/24/2023] Open
Abstract
Background The number of reports on sarcoidosis complicated by hypersensitivity pneumonitis (HP) is limited, and most describe cases complicated by chronic bird-related HP. Here, we present for the first time a case with Propionibacterium acnes-associated sarcoidosis complicated by acute bird-related HP. Case presentation A 62-year-old man with a past medical history of sarcoidosis was admitted to our department, and chest computed tomography showed diffuse ground-glass opacities, which appeared as he rapidly increased the number of pigeons he kept for a competition. Random transbronchial lung biopsy revealed well-formed non-caseating epithelioid granulomas, which contained positively stained substances on immunohistochemistry using the PAB antibody, a specific monoclonal antibody against P. acnes lipoteichoic acid. Poorly formed non-caseating granulomas without positively stained substances were also detected. Conclusion We describe the successful identification of this exceptionally rare case of sarcoidosis complicated by acute bird-related HP in which two morphologically and immunohistologically different types of granulomas were present in the same lung.
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Affiliation(s)
- Michiru Sawahata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan.
| | - Noritaka Sakamoto
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan
| | - Hideaki Yamasawa
- Department of Pulmonary Medicine, International University of Health and Welfare, Nasushiobara, Japan
| | - Yuki Iijima
- Department of Pulmonary Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Hirotoshi Kawata
- Department of Pathology, Jichi Medical University, Shimotsuke, Japan
| | | | - Keisuke Uchida
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan
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19
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Naur TMH, Bodtger U, Nessar R, Salih GN, Clementsen PF. Asymptomatic silicone induced granulomatous disease diagnosed by endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA). Respir Med Case Rep 2020; 30:101102. [PMID: 32551219 PMCID: PMC7289761 DOI: 10.1016/j.rmcr.2020.101102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/11/2020] [Accepted: 05/20/2020] [Indexed: 10/25/2022] Open
Abstract
Silicone from ruptured breast implants can cause lung symptoms mimicking cancer. The diagnosis may be established by transbronchial lung biopsy or surgery. We report a case of asymptomatic silicone induced granulomatous reaction in the lungs and mediastinal lymph nodes diagnosed with EBUS-TBNA. We conclude that this differential diagnosis should be kept in mind even in an asymptomatic patients and that EBUS-TBNA should be considered.
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Affiliation(s)
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Rafi Nessar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Ghanem M, Naccache JM, Bonneterre V, L'huillier JP, Guillaud Segard B, Lazor R, Tazi A, Gondouin A, Israël-Biet D, Marquignon MF, Cottin V, Valeyre D, Marchand-Adam S. [Diagnostic difficulties of chronic pulmonary berylliosis in France]. Rev Mal Respir 2020; 37:364-368. [PMID: 32279890 DOI: 10.1016/j.rmr.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 03/04/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The epidemiology of chronic beryllium disease (CBD) in France is poorly understood. The aim of this study was to determine the number of prevalent cases of CBD in France between 2010 and 2014. METHODS We conducted a national survey using a specific questionnaire distributed by the professional pathology services. RESULTS In total, 33 CBD cases were reported in France, with a diagnosis established between 1982 and 2014. 85% (28/33) of CBD cases resulted from professional exposure and mostly concerned foundry workers (39%). A definite diagnosis defined by the association of an abnormal beryllium lymphocyte proliferation test and of a granulomatous inflammatory response in the lung, was obtained in 29/33 cases (88%). The other cases were probable CBD, defined by a granulomatous lung disease with a beryllium exposure, but without evidence of beryllium sensitisation. The diagnosis of granulomatous disease was confirmed a mean of 4 years after the end of exposure. The median delay between diagnosis of a granulomatous disease and diagnosis of CBD was 2 years (range 0-38 years). A genetic predisposition was found in 14 of 17 tested patients (82%). CONCLUSION In this study, we report 33 cases of CBD followed in France between 2010 and 2014. The poor understanding of CBD and the exposure leading to it, the late development after the end of exposure, the complexity of the diagnosis and the similarities with sarcoidosis may explain the small number of cases reported.
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Affiliation(s)
- M Ghanem
- Service de pneumologie, centre de compétences des maladies pulmonaires rares de la région Centre, hôpital Bretonneau, CHRU de Tours, Tours, France
| | - J M Naccache
- Service de pneumologie, centre constitutif pour les maladies pulmonaires rares, hôpital Avicenne, CHU de Paris Seine-Saint-Denis, Bobigny, France
| | - V Bonneterre
- Médecine du travail, CHU de Grenoble, Grenoble, France
| | - J P L'huillier
- Service de pneumologie, centre hospitalier intercommunal, Créteil, France
| | | | - R Lazor
- Service de pneumologie, CHU de Vaudois, Lausanne, Suisse
| | - A Tazi
- Service de pneumologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - A Gondouin
- Service de pneumologie, CHRU de Besançon, Besançon, France
| | - D Israël-Biet
- Service de pneumologie, faculté de médecine Paris Descartes, centre de compétence maladies pulmonaires rares, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | | | - V Cottin
- Service de pneumologie, CHU de Vaudois, Lausanne, Suisse
| | - D Valeyre
- Service de pneumologie, centre constitutif pour les maladies pulmonaires rares, hôpital Avicenne, CHU de Paris Seine-Saint-Denis, Bobigny, France
| | - S Marchand-Adam
- Service de pneumologie, centre de compétences des maladies pulmonaires rares de la région Centre, hôpital Bretonneau, CHRU de Tours, Tours, France; CEPR InsermU1100, Université Francois-Rabelais de Tours, Tours, France.
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21
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Novo-González B, González-García L, Samperiz-Abad G, Bakali-Badesa S, Alberdi-Viñas J. Neurosarcoidosis presenting with isolated intracranial mass lesion and communicating hydrocephalus. Neurocirugia (Astur) 2019; 31:306-312. [PMID: 31882303 DOI: 10.1016/j.neucir.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/05/2019] [Accepted: 10/27/2019] [Indexed: 10/25/2022]
Abstract
Isolated neurosarcoidosis is a very rare disease, which makes up 5-15% of sarcoidosis cases. Hydrocephalus is a rare clinical feature with a prevalence of 6% among these patients. Considering neurosarcoidosis in the differential diagnosis of a unique parenquimal mass lesion could help in the early identification of this disease. We report the case of a 27-year-old African man who developed with a sole intracranial mass lesion mimicking radiologically a glioma, which finally came out as an isolated neurosarcoidosis. There is a difficulty in diagnosis when isolated neurosarcoidosis appears. In addition, the low prevalence of the disease entails a not standardized medical treatment. Natural outcome is poor even when hydrocephalus is resolved. Multimodal treatments including complete pharmacological treatment do not seem to assure a better outcome in these patients until date.
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Affiliation(s)
| | | | - Gloria Samperiz-Abad
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Juan Alberdi-Viñas
- Neurosurgery Department, Miguel Servet University Hospital, Zaragoza, Spain
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22
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Affiliation(s)
- Angela Cropley
- Nepean Hospital, Derby St, Kingswood, Sydney, Australia.
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23
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Mehrzad R, Festa J, Bhatt R. Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature. World J Clin Cases 2019; 7:2505-2512. [PMID: 31559285 PMCID: PMC6745330 DOI: 10.12998/wjcc.v7.i17.2505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sarcoidosis is a granulomatous disease of unknown etiology that most often impacts the lungs. Cutaneous manifestations of sarcoidosis are seen among 9%-37% of patients. Subcutaneous sarcoidosis is a rare presentation of cutaneous sarcoidosis with estimates of frequency ranging from 1.4%-16%. To date, very few articles and case reports have been written about this subject. In this paper, we describe a case of subcutaneous sarcoidosis and perform a review of the literature to determine if there are commonalities among patients who present with subcutaneous sarcoidosis.
CASE SUMMARY A 38-year-old female, with a past medical history of arthritis and recurrent nephrolithiasis, presents with an 8-mo history of 4 firm, asymptomatic, skin-colored nodules on her left and right upper extremities and neck. Needle biopsy and post-excisional pathology report both revealed well-formed, dense, non-caseating granulomas localized to the subcutaneous tissue. Chest computed tomography revealed mild mediastinal lymphadenopathy. A diagnosis of subcutaneous sarcoidosis was made, and the lesions were surgically removed.
CONCLUSION Commonalities among patients presenting with subcutaneous sarcoidosis include: middle-aged female, lesions localizing to the upper or lower limbs, lymphadenopathy or pulmonary infiltration on chest imaging, elevated serum angiotensin-converting enzyme.
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Affiliation(s)
- Raman Mehrzad
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Julia Festa
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Reena Bhatt
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
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24
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Maddah M, Fazlollahi MR, Shiari R, Shahram F, Mamishi S, Babaie D, Monajemzadeh M, Sotudeh S, Hamidieh AA, Badalzadeh M, Tajik S, Sedighipour L, Pourpak Z. Lupus Erythematosus and Chronic Granulomatous Disease: Report of Four Iranian Patients with AR-CGD and One XL-CGD. Iran J Allergy Asthma Immunol 2019; 18:452-458. [PMID: 31522454 DOI: 10.18502/ijaai.v18i4.1426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/04/2018] [Indexed: 11/24/2022]
Abstract
Chronic granulomatous disease (CGD) is a rare genetic disorder of neutrophil activity, resulting in increased rate of recurrent infections with catalase-positive bacteria and fungi, as well as various autoimmune diseases such as sarcoidosis, rheumatoid arthritis, and discoid and/or systemic lupus erythematosus. Few reports have reported lupus erythematosus (LE) in patients with X-linked CGD (XL-CGD) and carriers, and very few in autosomal recessive CGD (AR-CGD). Here, we present 5 patients with CGD developing LE at different ages to emphasize on the importance of appropriate follow-up and treatment in patients with CGD with clinical signs and symptoms of autoimmune diseases and even in those with negative serologic results.
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Affiliation(s)
- Marzieh Maddah
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Fazlollahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Shiari
- Department of Pediatric Rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Shahram
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Setareh Mamishi
- Department of Infectious Diseases, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Delara Babaie
- Department of Allergy and Clinical Immunology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Monajemzadeh
- Department of Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheila Sotudeh
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amir Ali Hamidieh
- Department of Pediatric Stem Cell Transplantation, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Badalzadeh
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shaghayegh Tajik
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Leila Sedighipour
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Pourpak
- Immunology, Athma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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25
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Send T, Tuleta I, Koppen T, Thiesler T, Eichhorn KW, Bertlich M, Bootz F, Jakob M. Sarcoidosis of the paranasal sinuses. Eur Arch Otorhinolaryngol 2019; 276:1969-74. [PMID: 30900021 DOI: 10.1007/s00405-019-05388-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sarcoidosis is a chronic disease, which predominantly affects the lung. Since sinonasal sarcoidosis is rare, little is known about the sarcoidosis manifestation at this site. Therefore, the aim of our study was to detect the prevalence of sinonasal sarcoidosis, its clinical occurrence, diagnosis, and therapy. METHODS The database of all patients having visited the otorhinolaryngology departments of the universities in Göttingen and in Bonn between 2003 and 2016 was searched for the diagnosis of sinonasal sarcoidosis. RESULTS Thirteen patients with a biopsy-proven sinonasal sarcoidosis were identified. Most patients presented non-specific clinical symptoms, which are also found in acute and chronic sinusitis. None of the patients was suspected to have sinonasal sarcoidosis by the ENT doctor before histological validation. The mean diagnostic delay was 262 (± 195) days. An additional pulmonary involvement was detected in four of six patients. CONCLUSIONS Sinonasal sarcoidosis is presenting with heterogeneous clinical presentations. An early biopsy of granulomatous lesions is mandatory. A multidisciplinary approach is needed to exclude serious lung or heart manifestations, because even asymptomatic organ involvement is possible. A CT-scan may be useful even if unspecific. Local or systemic therapy has to be prepared individually using local and systemic corticosteroids, antimetabolites, or anti-TNF-alpha.
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26
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Chaabouni R, Bahloul E, Boudaya S, Frikha F, Amouri M, Turki H. [A rash of the face]. Rev Med Interne 2019; 40:696-697. [PMID: 30857824 DOI: 10.1016/j.revmed.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/10/2019] [Indexed: 11/17/2022]
Affiliation(s)
- R Chaabouni
- Service de dermatologie, centre hospitalo-universitaire Hédi-Chaker, 3029 Sfax, Tunisie.
| | - E Bahloul
- Service de dermatologie, centre hospitalo-universitaire Hédi-Chaker, 3029 Sfax, Tunisie
| | - S Boudaya
- Service de dermatologie, centre hospitalo-universitaire Hédi-Chaker, 3029 Sfax, Tunisie
| | - F Frikha
- Service de dermatologie, centre hospitalo-universitaire Hédi-Chaker, 3029 Sfax, Tunisie
| | - M Amouri
- Service de dermatologie, centre hospitalo-universitaire Hédi-Chaker, 3029 Sfax, Tunisie
| | - H Turki
- Service de dermatologie, centre hospitalo-universitaire Hédi-Chaker, 3029 Sfax, Tunisie
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27
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Sáenz González AF, Busquet I Duran N, Arámbulo O, Badal Alter JM. Chronic dacryocystitis caused by sarcoidosis. ACTA ACUST UNITED AC 2018; 94:188-191. [PMID: 30558969 DOI: 10.1016/j.oftal.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Sarcoidosis of lacrimal sac is a very uncommon disease. When the patient has symptoms of lacrimal sac diseases, it is necessary to take into account the histological evaluation, to demonstrate the involvement of the lacrimal sac by this pathology. In patients with sarcoidosis history, the treatment is surgical and it is suggested to do an external dacryocystorhinostomy, in order to take a biopsy, to get a diagnosis and to establish the incidence of this pathology. The case is presented of a 44 year-old female, with a history of sarcoidosis lymph nodes, who presented with a right chronic dacryocystitis of one year onset.
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Affiliation(s)
| | - N Busquet I Duran
- Servicio de Oftalmología, Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - O Arámbulo
- Servicio de Oftalmología, Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - J M Badal Alter
- Servicio de Anatomía Patológica, Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
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28
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Sumi M, Takagi Y, Sasaki M, Eida S, Katayama I, Hotokezaka Y, Nakamura T. Magnetic resonance perfusion and diffusion characteristics of granulomatous diseases mimic those of malignant lesions: six case reports. Oral Radiol 2018; 34:73-82. [PMID: 30484085 DOI: 10.1007/s11282-017-0271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
The perfusion and diffusion properties of a tumor are important clues in evaluating its growth potential and predicting its histological type, such as benign or malignant. Tumor perfusion can be estimated by assessing time-dependent changes in the intratumoral levels of the contrast agent during dynamic contrast-enhanced magnetic resonance (MR) imaging, whereas tumor diffusion can be estimated by assessing intratumoral water diffusivity on diffusion-weighted MR imaging. Granulomatous diseases with different etiologies occur in various head and neck regions, including the mandible, maxillary sinus, salivary glands, and lymph nodes. However, the perfusion and diffusion properties of granulomatous diseases in the head and neck regions are not well documented. In this study, we assessed the time-signal intensity curves and apparent diffusion coefficients of six granulomatous diseases of various histological types that appeared in the soft tissues of the head and neck. Our data show that the perfusion and diffusion characteristics of granulomatous diseases mimic those of malignant diseases, highlighting the need for careful interpretation of MR perfusion and diffusion findings to distinguish between granulomatous diseases and cancers of the head and neck region. Clinicians should pay particular attention to blood examination and biopsy results when interpreting imaging findings.
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29
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Amer MA, Tomoum MO. Long-term follow-up of repair of external nasal deformities in rhinoscleroma patients. J Craniomaxillofac Surg 2018; 46:2138-2143. [PMID: 30322780 DOI: 10.1016/j.jcms.2018.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rhinoscleroma (RS) is a chronic, progressive, granulomatous infectious disease endemic in Egypt and the Middle East, affecting the nose in 95-100% of cases, and resulting in functional and esthetic sequelae. The aim of the study was to investigate the feasibility of performing reconstructive procedures to improve external deformities in RS patients, with long-term follow up. PATIENTS & METHODS This prospective, controlled cohort study included 25 patients who were seeking rhinoplasty to improve their esthetic appearance, with evident clinical and histopathological history of RS. Another 25 patients seeking esthetic augmentation rhinoplasty in the same period formed the control group. All the participants were evaluated objectively by two independent rhinoplasty surgeons, and subjectively with ROE 2 years postoperatively. RESULTS All the participants showed significant improvement in esthetic facial evaluation postoperatively, with a correlative rise in ROE score. There was an insignificant difference between the studied groups. Inconsequential complications were encountered throughout the follow-up period, but with insignificant incidence in both groups. CONCLUSION Rhinoplasty for correction of RS external deformities is both safe and beneficial, with no risks of flaring up or increased complications. LEVEL OF EVIDENCE Level 2b.
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Abstract
Cutaneous granulomatosis is a heterogeneous group of diseases, characterized by a skin inflammatory reaction triggered by a wide variety of stimuli, including infections, foreign bodies, malignancy, metabolites, and chemicals. From a pathogenic point of view, they are divided into non-infectious and infectious granulomas. Pathophysiological mechanisms are still poorly understood. Non-infectious granulomatous skin diseases include granuloma annulare, necrobiosis lipoidica, rheumatic nodules, foreign body granulomas, cutaneous sarcoidosis, and interstitial granulomatous dermatitis. Necrobiosis lipoidica is more frequent in diabetic patients. Infectious granulomas of the skin are caused by mycobacteria, in particular Mycobacterium tuberculosis or atypical mycobacteria; parasites, such as Leishmania; or fungi. Pathogenic mechanisms of M. tuberculosis-related granuloma are discussed. From a clinical point of view, it is useful to divide cutaneous granulomatosis into localized and more disseminated forms, although this distinction can be sometimes artificial. Three types of localized granulomatous lesions can be distinguished: palisaded granulomas (granuloma annulare, necrobiosis lipoidica, and rheumatoid nodules), foreign body granulomas, and infectious granulomas, which are generally associated with localized infections. Disseminated cutaneous granulomas can be divided into infectious, in particular tuberculosis, and non-infectious forms, among which sarcoidosis and interstitial granulomatous dermatitis. From a histological point of view, the common denominator is the presence of a granulomatous inflammatory infiltrate in the dermis and/or hypodermis; this infiltrate is mainly composed of macrophages grouped into nodules having a nodular, palisaded or interstitial architecture. Finally, we propose which diagnostic procedure should be performed when facing a patient with a suspected cutaneous granulomatosis.
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Affiliation(s)
| | - Carlo Mainetti
- Department of Dermatology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | | | - Emmanuel Laffitte
- Clinique de Dermatologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland.
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Lopez-Sublet M, Caratti di Lanzacco L, Danser AHJ, Lambert M, Elourimi G, Persu A. Focus on increased serum angiotensin-converting enzyme level: From granulomatous diseases to genetic mutations. Clin Biochem 2018; 59:1-8. [PMID: 29928904 DOI: 10.1016/j.clinbiochem.2018.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/29/2018] [Accepted: 06/15/2018] [Indexed: 12/19/2022]
Abstract
Angiotensin I-converting enzyme (ACE) is a well-known zinc-metallopeptidase that converts angiotensin I to the potent vasoconstrictor angiotensin II and degrades bradykinin, a powerful vasodilator, and as such plays a key role in the regulation of vascular tone and cardiac function. Increased circulating ACE (cACE) activity has been reported in multiple diseases, including but not limited to granulomatous disorders. Since 2001, genetic mutations leading to cACE elevation have also been described. This review takes advantage of the identification of a novel ACE mutation (25-IVS25 + 1G > A) in two Belgian pedigrees to summarize current knowledge about the differential diagnosis of cACE elevation, based on literature review and the experience of our centre. Furthermore, we propose a practical approach for the evaluation and management of patients with elevated cACE and discuss in which cases search for genetic mutations should be considered.
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Affiliation(s)
| | - Lorenzo Caratti di Lanzacco
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - A H Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, The Netherlands
| | - Michel Lambert
- Division of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ghassan Elourimi
- Internal Medicine Department, University Hospital Avicenne, Bobigny, AP-HP, France
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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de Oliveira Souza Beltrão L, Pangracio M, da Silva Souza C. Sarcoid-Like Paracoccidioidomycosis in a Female Urban Dweller: Reviewing a Rare Clinical Condition in Brazil. Mycopathologia 2018; 183:847-852. [PMID: 29737451 DOI: 10.1007/s11046-018-0266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
We discuss the sarcoid-like clinical presentation, a rare type of infiltrative paracoccidioidomycosis (PCM) that is almost exclusively cutaneous, involves the face and histologically has a tuberculoid granulomatous pattern with few fungi. It is often misdiagnosed. In endemic regions of Brazil, PCM is more common among men from rural areas, while women of a reproductive age appear to be protected. We report the sarcoid-like PCM in a female urban dweller and highlight the main findings of a literature review.
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Affiliation(s)
- Larissa de Oliveira Souza Beltrão
- Hospital of Clinics of Ribeirão Preto, Division of Dermatology of Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mayara Pangracio
- Hospital of Clinics of Ribeirão Preto, Division of Dermatology of Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cacilda da Silva Souza
- Hospital of Clinics of Ribeirão Preto, Division of Dermatology of Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. .,Divisão de Dermatologia, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, CEP: 14048-900, Brazil.
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Zuelgaray E, Sallé de Chou C, Vignon-Pennamen MD, Battistella M, Leonard-Louis S, Hefez L, Guibal F, Bagot M, Bouaziz JD. [Sarcoid-like granulomatosis associated with eosinophilic fasciitis]. Ann Dermatol Venereol 2017; 145:37-42. [PMID: 28967434 DOI: 10.1016/j.annder.2017.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/12/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is a rare condition characterized by swelling of the extremities, sclerodermatous evolution and frequent hypereosinophilia. Hematological disorders, including aplastic anemia, solid tumors and autoimmune diseases, may be associated with EF. EF is usually not associated with granulomatous diseases. CASE REPORT Herein we describe the case of an 80-year-old man with symmetrical swelling and sclerosis of the legs, typical of EF, associated with skin and lymph node granulomas. Oral prednisone treatment resulted in complete clinical remission. DISCUSSION Association of EF and granulomatous disease is uncommon. Our case highlights the possible association of EF with sarcoidosis-like reactions.
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Affiliation(s)
- E Zuelgaray
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Sallé de Chou
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris VII, 75010 Paris, France
| | - M-D Vignon-Pennamen
- Service d'anatomie pathologique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Battistella
- Service d'anatomie pathologique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris VII, 75010 Paris, France
| | - S Leonard-Louis
- Service de neuropathologie, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Hefez
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - F Guibal
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Bagot
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris VII, 75010 Paris, France
| | - J-D Bouaziz
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris VII, 75010 Paris, France.
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Nath VG, Sahoo R, Sahoo A, Barad JK, Arun KA. Idiopathic Granulomatous Mastitis: A Clinical Puzzle in Breast Lump Cases. J Clin Diagn Res 2017; 11:PD14-PD15. [PMID: 28764247 DOI: 10.7860/jcdr/2017/27016.10089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign disease, characterized by chronic inflammation and granulomatous disease process. A middle aged lady with breast lump for six months with equivocal mammographic and ultrasound results underwent lumpectomy and biopsy. Ruling out all other possible granulomatous diseases and malignancy, a diagnosis of IGM was made. IGM becomes clinically significant as it closely mimics carcinoma breast and some inflammatory and infectious pathology.
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Affiliation(s)
- Vivek G Nath
- Junior Resident, Department of General Surgery, SCB, Medical College, Cuttack, Odisha, India
| | - Rakesh Sahoo
- Senior Resident, Department of General Surgery, SCB, Medical College, Cuttack, Odisha, India
| | - Avinash Sahoo
- Junior Resident, Department of General Surgery, SCB, Medical College, Cuttack, Odisha, India
| | - Jithendra Kumar Barad
- Junior Resident, Department of General Surgery, SCB, Medical College, Cuttack, Odisha, India
| | - K A Arun
- Junior Resident, Department of General Surgery, SCB, Medical College, Cuttack, Odisha, India
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Peralta-Gómez MY, Ávila-Ocampo KA, Huerta-Velázquez S, Rivera-Salgado MI. Sarcoidosis of the lacrimal gland as a first manifestation. Arch Soc Esp Oftalmol (Engl Ed) 2018; 93:206-8. [PMID: 28610808 DOI: 10.1016/j.oftal.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/05/2017] [Accepted: 05/10/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/METHOD The first manifestation of sarcoidosis is usually at the pulmonary level. The case is described of a 40-year-old female patient, who presented with an increased volume of the lacrimal gland and mechanical ptosis of upper left eyelid as the first expression of this disease. RESULT/CONCLUSION The diagnosis of systemic sarcoidosis with primary presentation of the lacrimal gland was made after performing several immunological studies with negative results, imaging studies, and taking of glandular and lymph node biopsies. A favourable response was achieved with oral methotrexate treatment.
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Tan ES, Friesen B, Loh SF, Fox J. Immunoglobulin-G4 related mastitis: A case report. Int J Surg Case Rep 2017; 37:169-172. [PMID: 28735232 PMCID: PMC5522915 DOI: 10.1016/j.ijscr.2017.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/11/2017] [Accepted: 06/11/2017] [Indexed: 12/11/2022] Open
Abstract
IgG4-RM is exceedingly rare with only ten reported cases in the literatreu. Diagnosis of IgG4-RM is based exclusively on histological analysis. It is a benign chronic inflammatory process that can be treated sufficiently with excision or steroid. Extensive whole body imaging is generally not recommended unless the patient is symptomatic.
Introduction IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literature to date. Organs that are affected with IgG4-related disease (IgG4-RD) all share the same histopathological hallmarks consisting of dense lymphocytic infiltration, storiform fibrosis and obliterative phlebitis. Presentation of case This case report highlights a case of IgG4-RM found incidentally in a 52-year-old woman during a routine breast screen and it explores the current literature about IgG4-RM and IgG4-RD. Discussion IgG4-RM and IgG4-RD, in general, is a new entity in the field of medicine and its aetiology is not well understood. In the literature, IgG4-RM often presents as a painless palpable breast lump in isolation or with other systemic manifestations. IgG4-RM is considered benign and has excellent prognosis post-conservative treatment with steroid or surgical excision. Conclusion IgG4-RM is diagnosed exclusively on histological analysis. It is hard to distinguish IgG4-RD from malignant breast lesions purely on clinical examination and imaging studies. Increasing awareness of this condition among clinicians will assist them in managing patients better. Extensive whole body imaging is not recommended unless symptomatic.
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Affiliation(s)
- Ee Syn Tan
- Department of General Surgery (Monash Health), 135-145 David Street, Dandenong, VIC 3175, Australia.
| | - Brendon Friesen
- Lake Imaging, St John of God Hospital, Geelong, VIC, Australia
| | - Seow Foong Loh
- Department of Breast Surgery (Monash Health), Moorabbin Hospital, 823-865 Centre Rd, Bentleigh East, VIC 3165, Australia
| | - Jane Fox
- Department of Breast Surgery (Monash Health), Moorabbin Hospital, 823-865 Centre Rd, Bentleigh East, VIC 3165, Australia
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Gómez-Verdú JM, Valero Cifuentes S, Pastor Quirante F, López-Andreu FR. Acute sarcoid myopathy: a case report and literature review. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:413-415. [PMID: 28079855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 06/06/2023]
Abstract
Sarcoidosis is a worldwide spread disease with brad clinical spectrum, in which the pulmonary involvement is the main manifestation (more than 90% of cases); nevertheless, extrathoracic symptoms can predominate in the clinical picture and they may even be the first manifestation. One of them is the skeletal muscle involvement that normally is chronic and silent, with poor response to treatment with glucocorticoids. However, in some cases, it has an acute presentation. We present a case of a 61-year-old man with diagnosis of sarcoidosis whe were evaluated for proximal lower limb weakness within few days of evolution.
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Abstract
Common variable immunodeficiency (CVID) is frequently complicated by the development of autoimmune and lymphoproliferative diseases. With widespread use of immunoglobulin replacement therapy, autoimmune and lymphoproliferative complications have replaced infection as the major cause of morbidity and mortality in CVID patients. Certain CVID complications, such as bronchiectasis, are likely to be the result of immunodeficiency and are associated with infection susceptibility. However, other complications may result from immune dysregulation rather than immunocompromise. CVID patients develop autoimmunity, lymphoproliferation, and granulomas in association with distinct immunological abnormalities. Mutations in transmembrane activator and CAML interactor, reduction of isotype-switched memory B cells, expansion of CD21 low B cells, heightened interferon signature expression, and retained B cell function are all associated with both autoimmunity and lymphoproliferation in CVID. Further research aimed to better understand that the pathological mechanisms of these shared forms of immune dysregulation may inspire therapies beneficial for multiple CVID complications.
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Affiliation(s)
- Paul J Maglione
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1089, New York, NY, 10029, USA.
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Guidry JA, Downing C, Tyring SK. Deep Fungal Infections, Blastomycosis-Like Pyoderma, and Granulomatous Sexually Transmitted Infections. Dermatol Clin 2015; 33:595-607. [PMID: 26143434 DOI: 10.1016/j.det.2015.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Blastomycosis-like pyoderma is a clinically similar condition, which is caused by a combination of hypersensitivity and immunosuppression. Successful treatment has been reported with antibiotics and, more recently, the vitamin A analog, acitretin. Granuloma inguinale and lymphogranuloma venereum cause ulcerative genital lesions with a granulomatous appearance on histology. The Centers for Disease Control and Prevention recommens treatment of these genital infections with doxycycline.
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Hippe S, Kellner N, Seliger G, Wiechmann V, Grünewald T. [Q fever : A rare differential diagnosis of granulomatous disease]. Pathologe 2016; 37:269-74. [PMID: 26919849 DOI: 10.1007/s00292-016-0154-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Q fever is a worldwide distributed zoonotic disease with a mostly benign course, which regularly reoccurs in Germany. This report is about a patient with sporadic serologically proven Q fever, which also showed typical histopathological findings with nonspecific granulomatous hepatitis, usually seen in acute disease. The bone marrow biopsy revealed so-called doughnut granulomas, which are not pathognomonic but a typical finding in Q fever. This case report impressively underlines that the histomorphological findings can make a decisive contribution to the clarification by extended differential diagnostics, even though it plays a subordinate role in the routine diagnostics of disseminated Q fever.
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Abstract
INTRODUCTION Innate or acquired immune deficiency may show respiratory manifestations, often characterized by small airway involvement. The purpose of this article is to provide an overview of small airway disease across the major causes of immune deficiency. BACKGROUND In patients with common variable immune deficiency, recurrent lower airway infections may lead to bronchiolitis and bronchiectasis. Follicular and/or granulomatous bronchiolitis of unknown origin may also occur. Bronchiolitis obliterans is the leading cause of death after the first year in patients with lung transplantation. Bronchiolitis obliterans also occurs in patients with allogeneic haematopoietic stem cell transplantation, especially in the context of systemic graft-versus-host disease. VIEWPOINT AND CONCLUSION Small airway diseases have different clinical expression and pathophysiology across various causes of immune deficiency. A better understanding of small airways disease pathogenesis in these settings may lead to the development of novel targeted therapies.
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Affiliation(s)
- P-R Burgel
- Université Paris Descartes, Sorbonne Paris Cité, 75005 Paris, France; Service de pneumologie, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - A Bergeron
- Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de pneumologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - C Knoop
- Department of Chest Medicine, Erasme University Hospital, université libre de Bruxelles, Bruxelles, Belgique
| | - D Dusser
- Université Paris Descartes, Sorbonne Paris Cité, 75005 Paris, France; Service de pneumologie, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Abstract
Sarcoidosis is a multisystem granulomatous disease, which is usually associated with the formation of noncaseating granulomas in affected tissues and organs. It is mostly present with bilateral hilar lymphadenopathy, pulmonary infiltration, ocular, and cutaneous lesions. Oral manifestations of this disease are relatively rare. The present case report shows a 40-year-old male with lesions in the soft tissue of oral cavity (buccal mucosa, gingiva, and palate) and a diagnosis of sarcoidosis was established following hematological, biochemical and pulmonary function tests, chest radiograph, and histopathological investigation.
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Affiliation(s)
- Sanjay Gupta
- Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Amitandra Kumar Tripathi
- Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Vivek Kumar
- Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Charanjit Singh Saimbi
- Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
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Abstract
Sarcoidosis is a granulomatous disease that mainly affects the lungs and intrathoracic lymph nodes; however, virtually any organ can be affected. As an orphan disease, recommendations are mainly based on observational or small randomized studies as well as experts' opinion. Diagnosing sarcoidosis requires proof of non-necrotizing granulomas in patients with a compatible symptomatic pattern and the exclusion of other granulomatous diseases. Granulomas can be detected best in the lungs or intrathoracic lymph nodes. Therefore, bronchoscopy and endobronchial ultrasound with biopsies of lymph nodes are the major tools to diagnose sarcoidosis. Frequently, close follow-up and symptomatic therapy are sufficient to allow for spontaneous resolution. In case of functional organ impairment, cardial or CNS involvement, or other complications, steroid therapy is necessary with a starting dose of 0.5 mg/kg body weight that should be tapered-off over 6-12 months. Steroid-refractory disease can be treated by adding methotrexate or azathioprine, two drugs long known in sarcoidosis treatment. Monoclonal antibodies against TNF and lung transplantation are further therapeutic options.
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Affiliation(s)
- B C Frye
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - J C Schupp
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - T L Köhler
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - J Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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Strychowsky JE, Vargas SO, Cohen E, Vielman R, Son MB, Rahbar R. Laryngeal sarcoidosis: presentation and management in the pediatric population. Int J Pediatr Otorhinolaryngol 2015; 79:1382-7. [PMID: 26148428 DOI: 10.1016/j.ijporl.2015.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sarcoidosis is a disease characterized by systemic non-necrotizing granulomas of unknown etiology. Laryngeal sarcoidosis is extremely uncommon, especially among pediatric patients. The clinical presentation and management of this entity in the pediatric population are poorly understood. METHODS A comprehensive search in PubMed was conducted to identify all cases in the published literature. We also present a case of isolated pediatric laryngeal sarcoidosis and outline the multidisciplinary approach to evaluation and management. RESULTS A previously healthy 13-year-old female presented with a five-month history of mild dysphonia, dyspnea on exertion, and diffuse supraglottic edema. Biopsy showed non-necrotizing granulomas. Treatment with methotrexate led to marked improvement. The literature search identified seven previously published cases of pediatric laryngeal sarcoidosis, four in which disease was isolated to the larynx. All patients presented with a symptomatic and diffusely edematous supraglottis. Diagnoses were based on supraglottic biopsies showing non-necrotizing granulomas; all other possible etiopathologies were excluded. Three patients responded to corticosteroid therapy alone, one patient to tumor necrosis factor (TNF) inhibitor and methotrexate, and the remainder to a combination of corticosteroid therapy and surgical debulking. CONCLUSIONS Laryngeal sarcoidosis in the pediatric population is challenging to diagnose and manage. When epithelioid granulomas are encountered histologically, other causes of granulomatous inflammation must be ruled out before a diagnosis of sarcoidosis can be made. Corticosteroid therapy alone may be ineffective. Medical therapy with methotrexate alone or in combination with TNF inhibitors versus surgical debulking alone or as part of multimodality treatment should be considered. A multidisciplinary approach with involvement of an otolaryngologist, pathologist, and rheumatologist is suggested.
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Zujić PV, Grebić D, Valenčić L. Chronic granulomatous inflammation of the breast as a first clinical manifestation of primary sarcoidosis. Breast Care (Basel) 2015; 10:51-3. [PMID: 25960726 DOI: 10.1159/000370206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis is an idiopathic multisystemic disease that affects young to middle aged adults, with higher incidence in women. Although it may involve the breast parenchyma, primary sarcoidosis of the breast is very rare. It occurs in less than 1% of cases. In a differential diagnosis it may potentially be considered a malignancy. CASE REPORT We report a case in which breast sarcoidosis was the first clinical manifestation of systemic disease in a 54-year-old woman who presented with wide erythematous skin changes associated with palpable induration. Considering the fact that physical examination and the results of mammography, ultrasound and magnetic resonance imaging were inconclusive and unable to rule out malignancy, biopsy was performed. Pathohistological diagnosis showed a non-necrotizing granulomatous inflammation without elements of breast cancer. Sarcoidosis was confirmed with elevated level of angiotensin-converting enzyme in the sera and characteristic chest multislice computed tomography findings. The bronchoalveolar lavage was infiltrated with lymphocytes. CONCLUSION Breast sarcoidosis has diverse and nonspecific imaging characteristics. Carcinoma must always be excluded by core needle biopsy. Achieving correct diagnosis is mandatory so that adequate corticosteroid therapy can be applied as early as possible. A multidisciplinary approach is of utmost importance in the diagnostic workup.
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Affiliation(s)
- Petra Valković Zujić
- Department of Radiology, Clinical Hospital Center Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Damir Grebić
- Department of Surgery, Clinical Hospital Center Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Lara Valenčić
- Student of General Medicine, Medical Faculty of Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
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Abstract
Pediatric granulomatous diseases constitute a heterogenous group of conditions in terms of clinical phenotypes, pathogenic mechanisms, and outcomes. The common link is the presence of multinucleated giant cells in the inflammatory infiltrate. The clinical scenario in which a tissue biopsy shows granulomatous inflammation is not an uncommon one for practicing adult and pediatric rheumatologists. Our role as rheumatologists is to develop a diagnostic plan based on a rational differential diagnostic exercise tailored to the individual patient and based mainly on a detailed clinical assessment. This chapter presents a comprehensive differential diagnosis associated with a classification developed by the authors. We describe with some detail extrapulmonary sarcoidosis, Blau syndrome, and immunodeficiency associated granulomatous inflammation, which in our view are the paradigmatic primary forms of granulomatous diseases in childhood. The other entities are presented only as differential diagnoses listing their most relevant clinical features. This chapter shows that almost all granulomatous diseases seen in adults can be found in children and that there are some entities that are essentially pediatric at onset, namely Blau syndrome and most forms of immunodeficiency associated granulomatous diseases.
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Affiliation(s)
- Carlos D Rose
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803-3607, USA.
| | - Benedicte Neven
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803-3607, USA
| | - Carine Wouters
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803-3607, USA
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47
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Pacheco C, Morais A, Rolo R, Ferreira L, Nabiço R, Cunha J. Chronic granulomatous disease associated with common variable immunodeficiency - 2 clinical cases. Rev Port Pneumol 2014; 20:219-22. [PMID: 24462347 DOI: 10.1016/j.rppneu.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/25/2013] [Accepted: 09/09/2013] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Chronic granulomatous disease associated with common variable immunodeficiency (GD-CVID), although well documented, is rare. Granulomatous lesions can affect several organs and are histologically indistinguishable from sarcoidosis. CLINICAL CASES Case 1: A 39-year-old male patient with CVID, asymptomatic although with thrombocytopenia and mediastinal-hilar adenopathies. GD-CVID was diagnosed by bone marrow biopsy. Progressive clinical and radiological improvement was obtained with corticotherapy. Case 2: A 38-year-old male patient with CVID, suffered from asthenia, anorexia, myalgia, lower limbs edemas, and dry cough. He had mediastinal and bilateral hilar adenopathies within which biopsy revealed non-necrotizing granulomatous infiltrate. A spontaneous resolution was detected after 9 months of evolution. CONCLUSION GD-CVID is rare and can mimetize other pathologies, namely, sarcoidosis; it should therefore be publicized and discussed so that it becomes a general clinical knowledge.
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Affiliation(s)
- C Pacheco
- Serviço de Pneumologia, Hospital de Braga, Braga, Portugal.
| | - A Morais
- Serviço de Pneumologia, Centro Hospitalar de São João; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - R Rolo
- Serviço de Pneumologia, Hospital de Braga, Braga, Portugal
| | - L Ferreira
- Serviço de Pneumologia, Hospital de Braga, Braga, Portugal
| | - R Nabiço
- Serviço de Medicina Interna, Hospital de Braga, Braga, Portugal
| | - J Cunha
- Serviço de Pneumologia, Hospital de Braga, Braga, Portugal
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48
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Mohammadpour M, Mamishi S, Oaji M, Pourpak Z, Parvaneh N. Successful treatment of fungal osteomyelitis with voriconazole in a patient with chronic granulomatous disease. Iran J Pediatr 2010; 20:487-90. [PMID: 23056752 PMCID: PMC3446094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Accepted: 04/02/2010] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. CASE PRESENTATION We describe a nine year-old boy with CGD who presented with aspergillus induced skull osteomyelitis. He was successfully treated with voriconazole after initial failure of amphotericin B therapy. CONCLUSION Currently, newer triazoles are recommended as initial therapy for invasive aspergillosis in immunodeficiency states such as CGD.
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Affiliation(s)
- Masoud Mohammadpour
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran,Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Setareh Mamishi
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran,Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, IR Iran,Corresponding Author: Address: Children's Medical Center, Dr Gharib St, 14194 Tehran, Iran. E-mail:
| | - Mahsa Oaji
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Pourpak
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Nima Parvaneh
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran,Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran,Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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