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Obi ON, Alqalyoobi S, Maddipati V, Lower EE, Baughman RP. High-Resolution CT Scan Fibrotic Patterns in Stage IV Pulmonary Sarcoidosis: Impact on Pulmonary Function and Survival. Chest 2024; 165:892-907. [PMID: 37879560 DOI: 10.1016/j.chest.2023.10.021] [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: 02/18/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Different patterns of fibrosis on high-resolution CT scans (HRCT) have been associated with reduced survival in some interstitial lung diseases. Nothing is known about HRCT scan patterns and survival in sarcoidosis. RESEARCH QUESTION Will a detailed description of the extent and pattern of HRCT scan fibrosis in patients with stage IV pulmonary sarcoidosis impact pulmonary function and survival? STUDY DESIGN AND METHODS Two hundred forty patients with stage IV sarcoidosis at two large tertiary institutions were studied. The earliest HRCT scan with fibrosis was reviewed for extent of fibrosis (< 10%, 10%-20%, and > 20%) and presence of bronchiectasis, upper lobe fibrocystic changes, basal subpleural honeycombing, ground-glass opacities (GGOs), large bullae, and mycetomas. Presence of sarcoidosis-associated pulmonary hypertension (SAPH) and pulmonary function testing performed within 1 year of HRCT were recorded. Patients were followed up until last clinic visit, death, or lung transplantation. RESULTS The mean age was 58.4 years. Seventy-four percent were Black, 63% were female, and mean follow-up was 7.4 years. Death or LT occurred in 53 patients (22%). Thirty-one percent had > 20% fibrosis, 25% had 10%-20% fibrosis, and 44% had < 10% fibrosis. The most common HRCT abnormalities were bronchiectasis (76%), upper lobe fibrocystic changes (36%), and GGOs (28%). Twelve percent had basal subpleural honeycombing, and 32% had SAPH. Patients with > 20% fibrosis had more severe pulmonary impairment, were more likely to have SAPH (53%), and had worse survival (44% mortality; P < .001). Upper lobe fibrocystic changes, basal subpleural honeycombing, and large bullae were associated with worse pulmonary function and worse survival. Patients with basal subpleural honeycombing had the worst pulmonary function and survival (55% mortality; P < .001). GGOs were associated with worse pulmonary function but not worse survival, and mycetomas were associated with worse survival but not worse pulmonary function. A Cox proportional hazards model indicated that basal subpleural honeycombing (hazard ratio, 7.95), diffusion capacity for carbon monoxide < 40% (HR, 5.67) and White race (hazard ratio, 2.61) were independent predictors of reduced survival. INTERPRETATION HRCT scan features of fibrotic pulmonary sarcoidosis had an impact on pulmonary function and survival. Presence of >20% fibrosis and basal subpleural honeycombing are predictive of worse pulmonary function and worse survival in patients with stage IV pulmonary sarcoidosis.
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Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
| | - Shehabaldin Alqalyoobi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC; Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Veeranna Maddipati
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati, Cincinnati, OH
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Kawanobe T, Yamaguchi T, Johkoh T, Kono C, Sawahata M, Shijubo N, Konno S, Tatsumi K. Central Bronchial Deformity in Pulmonary Sarcoidosis: A Finding Suggestive of an Upper Lobe Fibrotic Phenotype on Chest Images. Acad Radiol 2024; 31:1160-1167. [PMID: 37743162 DOI: 10.1016/j.acra.2023.08.034] [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: 05/21/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
RATIONALE AND OBJECTIVES Bronchial and lung parenchymal structural remodeling may occur due to disease progression in patients with pulmonary sarcoidosis; however, its mechanisms remain unclear. Central bronchial deformity (CBD) associated with shrinkage in the upper lobe (SUL) is often observed in such patients. This study aimed to examine the association between CBD and structural remodeling to identify features indicating disease severity on chest images. MATERIALS AND METHODS This retrospective cohort study included 72 patients with pulmonary sarcoidosis, excluding patients with only bilateral hilar lymphadenopathy. The participants were divided into with and without CBD groups to examine the association between CBD and other structural remodeling, including SUL, cyst and/or low attenuation area-like emphysema (Cyst/LAA), pleural/sub-pleural thickening (PT), and traction bronchiectasis (TrBE), in the upper lobe on chest images. The association of CBD phenotype with respiratory dysfunction was also examined. RESULTS CBD was highly associated with SUL (81.4% vs. 8.9%), Cyst/LAA (44.4% vs. 6.7%), and PT (59.2% vs. 3.7%). The respective odds ratios in the univariable and multivariable analyses were as follows: SUL, 45.1 and 39.9; Cyst/LAA, 11.2 and 14.2; and PT, 64.0 and 68.7. TrBE was frequently associated with CBD (22.25% vs. 4.4%); the odds ratio was 6.14 in the univariable analysis. Furthermore, participants with CBD exhibited lower %FVC and %DLCO. CONCLUSION CBD is significantly associated with lung remodeling (SUL, Cyst/LAA, TrBE, and PT) and respiratory dysfunction. CBD may be a crucial clinical phenotype to identify upper lobe fibrotic changes.
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Affiliation(s)
- Takeshi Kawanobe
- Department of Respiratory Medicine, JR Tokyo General Hospital, Shibuya-ku, Japan (T.K., C.K.).
| | - Tetsuo Yamaguchi
- Department of Respiratory Medicine, Shinjuku Tsurukame Clinic, Shibuya-ku, Japan (T.Y.)
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.)
| | - Chiyoko Kono
- Department of Respiratory Medicine, JR Tokyo General Hospital, Shibuya-ku, Japan (T.K., C.K.)
| | - Michiru Sawahata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Japan (M.S.)
| | - Noriharu Shijubo
- Department of Respiratory Medicine, JR Sapporo Hospital, Sapporo, Japan (N.S.)
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan (S.K.)
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan (K.T.)
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Savale L, Dorfmüller P, Boucly A, Jaïs X, Lacoste-Palasset T, Jevnikar M, Seferian A, Humbert M, Sitbon O, Montani D. Sarcoidosis-Associated Pulmonary Hypertension. Clin Chest Med 2024; 45:185-197. [PMID: 38245366 DOI: 10.1016/j.ccm.2023.08.007] [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] [Indexed: 01/22/2024]
Abstract
Pulmonary hypertension is a life-threatening complication of advanced sarcoidosis. Many mechanisms can cause an elevation of pulmonary pressure in sarcoidosis, leading to precapillary or postcapillary pulmonary hypertension. Sarcoidosis-associated pulmonary hypertension contributes to severe exertional dyspnea, reduced exercise capacity, and notably compromised the survival. Despite the critical functional and prognostic implications of pulmonary hypertension in sarcoidosis, there is a scarcity of specific guidelines on the management of these patients due to a lack of evidence. Hence, further research is required to identify subgroups of patients who may benefit from pulmonary arterial hypertension-targeted therapies and/or immunosuppressive therapies.
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Affiliation(s)
- Laurent Savale
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
| | - Peter Dorfmüller
- Pathology Department, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Straße 8, Gießen 35392, Deutschland; German Center for Lung Research (DZL), Giessen, Germany
| | - Athénaïs Boucly
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Thomas Lacoste-Palasset
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Mitja Jevnikar
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Andrei Seferian
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; AP-HP, Department of Respiratory and Intensive CareMedicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Abstract
Sarcoidosis is a systemic granulomatous disorder that affects individuals of all racial/ethnic origins and occurs at any time of life. Spontaneous remission is frequent and may occur in 2 of 3 patients, while the remaining cases have chronic, progressive disease, with some patients presenting with organ- and life-threatening involvements. Many reports have investigated which features may be related to poor outcomes in patients with sarcoidosis. Pulmonary hypertension and respiratory failure from pulmonary fibrosis are the most common complications associated with the cause of death in sarcoidosis. Other major causes of death include cardiac, neurologic, hepatic involvement, and hemoptysis from aspergilloma.
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Affiliation(s)
- Gamze Kırkıl
- Medicine Faculty, Department of Chest Disease, Firat University, Elazig 23200, Turkey.
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5
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Nunes H, Brillet PY, Bernaudin JF, Gille T, Valeyre D, Jeny F. Fibrotic Pulmonary Sarcoidosis. Clin Chest Med 2024; 45:199-212. [PMID: 38245367 DOI: 10.1016/j.ccm.2023.08.011] [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] [Indexed: 01/22/2024]
Abstract
Fibrotic pulmonary sarcoidosis (fPS) affects about 20% of patients. fPS carries a significant morbidity and mortality. However, its prognosis is highly variable, depending mainly on fibrosis extent, functional impairment severity, and the development of pulmonary hypertension. Moreover, fPS outcomes are also influenced by several other complications, including acute exacerbations, and infections. fPS natural history is unknown, in particular regarding the risk of progressive self-sustaining fibrosis. The management of fPS is challenging, including anti-inflammatory treatment if granulomatous activity persists, rehabilitation, and in highly selected patients antifibrotic treatment and lung transplantation.
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Affiliation(s)
- Hilario Nunes
- AP-HP, Pulmonology Department, Avicenne Hospital, Bobigny, 93009, France; INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France.
| | - Pierre-Yves Brillet
- INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France; AP-HP, Radiology Department, Avicenne Hospital, Bobigny, 93009, France
| | | | - Thomas Gille
- INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France; AP-HP, Physiology Department, Avicenne Hospital, Bobigny, 93009, France
| | - Dominique Valeyre
- INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France; Groupe Hospitalier Paris Saint-Joseph, Pulmonology Department, Paris, 75014 France
| | - Florence Jeny
- AP-HP, Pulmonology Department, Avicenne Hospital, Bobigny, 93009, France; INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France
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6
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Wang S, Dai H. Crazy-Paving Pattern in Pulmonary Sarcoidosis. N Engl J Med 2024; 390:e21. [PMID: 38416432 DOI: 10.1056/nejmicm2308650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Shiyao Wang
- China-Japan Friendship Hospital, Beijing, China
| | - Huaping Dai
- China-Japan Friendship Hospital, Beijing, China
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7
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Judson MA. Cough monitoring for pulmonary sarcoidosis. Respir Med 2024; 221:107483. [PMID: 38113960 DOI: 10.1016/j.rmed.2023.107483] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, MC-91, Albany Medical College, Albany, NY 12208, USA.
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8
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Lee JH, Han YE, Yang J, Kim HC, Lee J. Clinical manifestations and associated factors of uveitis in patients with pulmonary sarcoidosis: a case control study. Sci Rep 2023; 13:22380. [PMID: 38104161 PMCID: PMC10725472 DOI: 10.1038/s41598-023-49894-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023] Open
Abstract
Sarcoidosis, an idiopathic and inflammatory disease, affects various organs and can manifest as uveitis. Due to limited evidence, researchers investigated the risk factors associated with uveitis in patients with pulmonary sarcoidosis. A retrospective study was conducted on 71 pulmonary sarcoidosis patients, including 19 with uveitis and 52 without. Data on involved organs, imaging findings, spirometry, and analyses from blood and bronchoalveolar lavage fluid were collected. Logistic regression models were used for multivariate analysis. Among the 71 newly diagnosed pulmonary sarcoidosis patients, uveitis was observed in 19 patients (26.8%). No significant differences were found in clinical characteristics between patients with and without uveitis. Fewer patients with uveitis presented lung parenchymal lesions (P = 0.043). In multivariate analysis, skin lesions (aOR 7.619, 95% CI 1.277-45.472, P = 0.026) and ophthalmic symptoms (aOR 4.065, 95% CI 1.192-13.863, P = 0.025) were associated with uveitis. Absence of uveitis was related to lung parenchymal lesions (aOR 0.233, 95% CI 0.062-0.883, P = 0.032). Approximately one-quarter of patients with an initial diagnosis of pulmonary sarcoidosis were diagnosed with uveitis. Presence of skin lesions, ophthalmic symptoms, and absence of lung parenchymal lesions were related to uveitis. These results need to be clarified by further studies to confirm the clinical role of early ophthalmologic screening for pulmonary sarcoidosis patients with these factors.
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Affiliation(s)
- Jang Ho Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ye Eun Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jiyoul Yang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho Cheol Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Martins A, Pimenta S, Martins FR, Samões B, Nicolau R, Mariz E, Costa L. Pulmonary sarcoidosis and immune-mediated necrotizing myopathy: an uncommon coincidence. ARP Rheumatol 2023; 2:341-344. [PMID: 38174755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Immune-mediated necrotizing myopathy (IMNM) is characterized by acute or subacute, severe proximal muscle weakness and myofiber necrosis with minimal inflammatory cell infiltrate observed on muscle biopsy. On the other hand, sarcoidosis is characterised by the presence of non-caseating granulomas that can develop in several organs. CASE REPORT We present the unique case of a 49-year-old woman, with no previous medical history, who had a rare concomitant occurrence of IMNM and pulmonary sarcoidosis. This condition was successfully treated with a combination of corticosteroids and rituximab along with rehabilitation program. DISCUSSION This association has been reported in only two previous case reports. This highlights the importance of further research on the connection between sarcoidosis and other forms of inflammatory myopathies.
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Affiliation(s)
- Ana Martins
- Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sofia Pimenta
- Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Beatriz Samões
- Rheumatology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rafaela Nicolau
- Rheumatology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Eva Mariz
- Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lúcia Costa
- Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Gambichler T, Susok L, Doerler M, Dickel H, Chatzipantazi M. Löfgren syndrome associated with scleroedema adultorum of Buschke. Clin Exp Dermatol 2023; 48:39-40. [PMID: 36669186 DOI: 10.1093/ced/llac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/13/2022] [Indexed: 01/21/2023]
Abstract
A case of systemic sarcoidosis (Löfgren syndrome) associated with scleroedema adultorum of Buschke is reported. Sarcoidosis should be included in the spectrum of the underlying conditions of scleroedema adultorum of Buschke, and clinicians should be aware of this very rare association.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Laura Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Martin Doerler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Heinrich Dickel
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Maria Chatzipantazi
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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11
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Abstract
PURPOSE OF REVIEW In chronic pulmonary sarcoidosis, the transition from the inflammatory to the fibrotic stage of the lungs occurs in about 10-20% of cases, eventually causing end-stage fibrotic disease. To date, pathogenetic mechanisms and clinical management remain challenging; thus, we highlight the recent evidence in pulmonary fibrotic processes, clinical signs for an early detection and the potential role of the current investigated antifibrotic agents and promising targeted therapies. RECENT FINDINGS Recent findings of relevant key cellular pathways can be considered as a glimmer of light in the complexity of sarcoidosis. In some patients, granulomas persist and serve as a nidus for fibrosis growth, sustained by several fibrosis-stimulating cytokines. Preclinical studies have detected profibrotic, antifibrotic and pleiotropic T cells as promoters of fibrosis. Epigenetics, genetics and transcriptomics research can lead to new target therapies. Antifibrotic drug nintedanib has shown a positive effect on non-idiopathic pulmonary fibrosis fibrotic lung diseases including fibrotic sarcoidosis; other antifibrotic drugs are under investigation. SUMMARY Pulmonary fibrosis strongly impacts the outcome of sarcoidosis, and a better understanding of the underlying pathogenic mechanisms can facilitate the development of novel treatments, improving clinical care and life expectancy of these patients. The greatest challenge is to investigate effective antifibrotic therapies once fibrosis develops. The role of these findings in fibrotic sarcoidosis can be translated into other interstitial lung diseases characterized by the coexistence of inflammatory and fibrotic processes.
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Affiliation(s)
- Alessia Comes
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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12
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Abstract
PURPOSE We retrospectively analyzed the frequency and clinical characteristics of organs rarely involved with sarcoidosis in a cohort of 1158 sarcoidosis patients cared for over nearly 11 years in a university outpatient sarcoidosis clinic. METHODS Data were analyzed from an institution-approved sarcoidosis clinical database containing demographic and clinical characteristics of sarcoidosis outpatients cared for between May 2011 and March 2021 at a university medical center sarcoidosis clinic. The diagnosis of sarcoidosis was established by standard international criteria. Rare organ involvement was defined as an organ not individually listed in the Word Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Organ Assessment Instrument. RESULTS Twenty-six of the 1158 patients (2.2%) had 27 instances of rare organ involvement. The most common rare organ involved was the GI tract, followed by the testicle and then the female reproductive tract. Only 1 of the 26 patients with rare sarcoidosis organ involvement required therapy for that organ involvement. In comparison with sarcoidosis patients without rare organ involvement, patients with rare organ involvement were more likely to be black, have more total organs involved with sarcoidosis, and more likely require anti-sarcoidosis therapy at some point during the course of their disease. There were no differences between these groups in terms of sex, age at diagnosis, and most recent percent predicted forced vital capacity. CONCLUSIONS Rare sarcoidosis organ involvement occurred in 2.2 percent of this cohort. Although rare organ involvement rarely required treatment, it was associated with more extensive disease that was more likely to require therapy.
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Affiliation(s)
- Isam Albaba
- Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - M Fish Kenneth
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.
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13
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Takahashi Y, Kameda H, Miya A, Nomoto H, Cho KY, Nakamura A, Nishimura H, Kimura H, Suzuki M, Konno S, Shimizu A, Matsuno Y, Okamoto M, Motegi H, Iwata N, Fujisawa H, Suzuki A, Sugimura Y, Miyoshi H, Atsumi T. Lymphocytic panhypophysitis and anti-rabphilin-3A antibody with pulmonary sarcoidosis. Pituitary 2022; 25:321-327. [PMID: 35088194 DOI: 10.1007/s11102-021-01200-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore the clinical significance of anti-rabphillin-3A antibody for the differential diagnosis of lymphocytic panhypophysitis. METHODS AND RESULTS A 58-year-old Japanese man developed uveitis of unknown cause in 2017. In 2019, he became aware of polyuria. In August 2020, he noticed transient diplopia and was diagnosed with right abducens nerve palsy. At the same time, he complained of fatigue and loss of appetite. Head magnetic resonance imaging demonstrated enlargement of the pituitary stalk and pituitary gland, corresponding to hypophysitis. Hormone stimulation tests showed blunted responses with respect to all anterior pituitary hormones. Central diabetes insipidus was diagnosed on the basis of a hypertonic saline loading test. Taking these findings together, a diagnosis of panhypopituitarism was made. Computed tomography showed enlargement of hilar lymph nodes. Biopsies of the hilar lymph nodes revealed non-caseating epithelioid cell granulomas that were consistent with sarcoidosis. Biopsy of the anterior pituitary revealed mild lymphocyte infiltration in the absence of IgG4-positive cells, non-caseating granulomas, or neoplasia. Western blotting revealed the presence of anti-rabphilin-3A antibody, supporting a diagnosis of lymphocytic panhypophysitis. Because the patient had no visual impairment or severe uveitis, we continued physiological hormone replacement therapy and topical steroid therapy for the uveitis. CONCLUSION To the best of our knowledge, this is the first case of anti-rabphilin 3A antibody positive lymphocytic panhypophysitis comorbid with sarcoidosis, diagnosed by both pituitary and hilar lymph node biopsy. The utility of anti-rabphilin-3A antibody for the differential diagnosis of hypophysitis like this case should be clarified with further case studies.
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Affiliation(s)
- Yuka Takahashi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiraku Kameda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Aika Miya
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Nomoto
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kyu Yong Cho
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Akinobu Nakamura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroki Nishimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokazu Kimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ai Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Michinari Okamoto
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoko Iwata
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, Japan
- Department of Endocrinology and Diabetes, Daido Hospital, Nagoya, Japan
| | - Haruki Fujisawa
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, Japan
| | - Atsushi Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, Japan
| | - Yoshihisa Sugimura
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, Japan
| | - Hideaki Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
- Division of Diabetes and Obesity, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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Murakami K, Hata S, Ishibashi N, Kubota M, Eishi Y, Uchida K, Tabata T, Nakamura Y, Murakami K. A Solitary Necrotizing Sarcoid Granulomatosis-like Pulmonary Lesion Possibly Associated with Propionibacterium acnes and Mycobacterium avium. Intern Med 2021; 60:3773-3778. [PMID: 34121004 PMCID: PMC8710391 DOI: 10.2169/internalmedicine.7162-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report a case of a pulmonary necrotizing sarcoid granulomatosis (NSG)-like lesion possibly associated with coinfection of Mycobacterium avium and Propionibacterium acnes. A solitary nodule in the right middle lobe of the lung was notable for coagulative necrosis with aggregates of sarcoid-like epithelioid granulomas. Small arteries were damaged by granulomas. Both M. avium and P. acnes were detected in the lesion. Furthermore, more P. acnes genomes were detected in the granulomas than in the non-lesion lung. These findings blur the pathophysiologic boundaries among NSG, sarcoidosis, and mycobacteriosis, and suggest that NSG needs to be recognized as continuous spectra of sarcoidosis/mycobcteriosis.
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Affiliation(s)
- Keigo Murakami
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Shuko Hata
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Naoya Ishibashi
- Division of Thoracic Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Motoki Kubota
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Japan
| | - Keisuke Uchida
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Japan
| | - Toshiharu Tabata
- Division of Thoracic Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuhiro Murakami
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
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15
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Bénézit F, Le Bot A, Jouneau S, Lemaître F, Pronier C, Lentz PA, Patrat-Delon S, Revest M, Thibault V, Tattevin P. COVID-19 in Patient with Sarcoidosis Receiving Long-Term Hydroxychloroquine Treatment, France, 2020. Emerg Infect Dis 2020; 26:2513-2515. [PMID: 32609083 PMCID: PMC7510728 DOI: 10.3201/eid2610.201816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Because of in vitro studies, hydroxychloroquine has been evaluated as a preexposure or postexposure prophylaxis for coronavirus disease (COVID-19) and as a possible COVID-19 curative treatment. We report a case of COVID-19 in a patient with sarcoidosis who was receiving long-term hydroxychloroquine treatment and contracted COVID-19 despite adequate plasma concentrations.
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16
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Iriarte A, Rubio-Rivas M, Villalba N, Corbella X, Mañá J. Clinical features and outcomes of asymptomatic pulmonary sarcoidosis. A comparative cohort study. Respir Med 2020; 169:105998. [PMID: 32442109 DOI: 10.1016/j.rmed.2020.105998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics and outcomes of patients with asymptomatic pulmonary sarcoidosis (APS) detected incidentally and compare them with symptomatic non-Löfgren sarcoidosis (SnLS) patients. METHODS Patients diagnosed as having APS at a University hospital in Barcelona, Spain, followed prospectively from 1976 to 2018. APS was defined as the presence of bilateral hilar lymphadenopathy (BHL) with or without lung parenchymal involvement discovered incidentally on chest radiograph or CT scan. APS was compared with SnLS. RESULTS APS was diagnosed in 50 (13.6%) and SnLS in 317 (86.4%) patients. At diagnosis, stage I chest radiograph was significantly more frequent in APS than in SnLS (p < 0.001) and there were no asymptomatic patients with stages III and IV. SnLS showed more severe impairment in FVC (p = 0.009) and forced expiratory volume in 1st second (FEV1) (p = 0.003) than APS, while DLco was similar in both groups. Extrathoracic involvement at diagnosis and during the follow up was less frequent in APS than in SnLS patients (p < 0.005). Endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS) was the most used diagnostic tool. Treatment was more frequently required in the SnLS than in APS (p < 0.001). At five years, APS patients showed less presence of active disease than SnLS (p = 0.054). CONCLUSIONS APS showed earlier radiological stages, lesser impairment in lung function, extrapulmonary organ involvement and need for treatment than SnLS. EBUS was the most useful diagnostic tool. In spite of its benign presentation, around one third of patients evolved to persistent disease but usually with mild clinical and functional impairment.
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Affiliation(s)
- Adriana Iriarte
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Manuel Rubio-Rivas
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nadia Villalba
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Juan Mañá
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
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17
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Jeny F, Bernaudin JF, Valeyre D, Nunes H, Planès C, Besnard V. [Is hypoxia a factor in the progression of pulmonary sarcoidosis?]. Rev Mal Respir 2020; 37:214-217. [PMID: 32146058 DOI: 10.1016/j.rmr.2020.02.006] [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: 01/12/2020] [Accepted: 01/12/2020] [Indexed: 11/15/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease that can reduce life expectancy mainly due to pulmonary fibrosis resulting from granulomatous inflammation The lack of vascularization within pulmonary granulomas suggests that macrophages localized in the center of these structures are hypoxic. Hypoxia signaling pathways are known to be pro-inflammatory and pro-fibrotic in various pathological conditions. Recent data suggest an involvement of the transcription factor hypoxia-inducible factor (HIF) in the pathogenesis of sarcoidosis. This could represent a new research approach for the understanding and therapeutic management of sarcoidosis.
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Affiliation(s)
- F Jeny
- UMR 1272 hypoxie & poumon, Inserm-université Paris 13, SMBH, Bobigny, France; Service de pneumologie, hôpital Avicenne AP-HP, Bobigny, France.
| | - J-F Bernaudin
- UMR 1272 hypoxie & poumon, Inserm-université Paris 13, SMBH, Bobigny, France; Service de pneumologie, hôpital Avicenne AP-HP, Bobigny, France; Faculté de médecine, Sorbonne université, Paris, France
| | - D Valeyre
- UMR 1272 hypoxie & poumon, Inserm-université Paris 13, SMBH, Bobigny, France; Service de pneumologie, hôpital Avicenne AP-HP, Bobigny, France
| | - H Nunes
- UMR 1272 hypoxie & poumon, Inserm-université Paris 13, SMBH, Bobigny, France; Service de pneumologie, hôpital Avicenne AP-HP, Bobigny, France
| | - C Planès
- UMR 1272 hypoxie & poumon, Inserm-université Paris 13, SMBH, Bobigny, France; Service d'explorations fonctionnelles, hôpital Avicenne AP-HP, Bobigny, France
| | - V Besnard
- UMR 1272 hypoxie & poumon, Inserm-université Paris 13, SMBH, Bobigny, France
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18
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Abstract
Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.
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Affiliation(s)
- Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Department of Inflammation and Immunity, Lerner Research Institute Cleveland Clinic, Cleveland, OH, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
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19
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Bamidele A, Adnan S, Aled P. An Unusual Cause of Sudden Cardiac Death. West Afr J Med 2019; 36:286-289. [PMID: 31622494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sarcoidosis is a chronic granulomatous disease with multi-systemic involvement and with varied forms of presentation. The diagnosis can often be a challenge particularly due to the non-specific nature of the disease. It is often silent and may require no active treatment except during flares. We present the case of a middle age lady with pulmonary sarcoidosis who had sudden death from cardiac affectation without prior cardiac symptoms. We concluded that active cardiac assessment is a prudent step in patients presenting with sarcoidosis regardless of the organ of affectation at presentation or diagnosis.
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Affiliation(s)
- A Bamidele
- County Hospital, Hereford, Wye Valley Trust,England
| | - S Adnan
- County Hospital,Hereford,Respiratory Medicine
| | - P Aled
- Wye Valley NHS trust, Respiratory Department, County Hospital, Hereford
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20
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Heyne S, Hägele B, Beissert S, Günther C. Linear Hyperkeratotic Papules on Extremities Together with Oral Ulcers: A Quiz. Acta Derm Venereol 2019; 99:939-940. [PMID: 31197385 DOI: 10.2340/00015555-3239] [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] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stefanie Heyne
- Department of Dermatology, University Hospital Dresden, DE-01307 Dresden, Germany.
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21
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Díaz-Cabanas L, Belani-Raju M, González-Márquez PI, Artioli-Schellini S, Guereñu-Panero I, Galindo-Ferreiro A. Sarcoidosis in the periocular scar as the first finding of systemic sarcoidosis: Clinical-radiological characteristics. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:453-459. [PMID: 31036427 DOI: 10.1016/j.oftal.2019.03.006] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/01/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
An unusual case is presented of a 29 year-old Caucasian woman with a granuloma in an old scar in the right periocular region as a first clinical sign of a systemic sarcoidosis. An excisional biopsy was performed, for which the histological diagnosis was a chronic non-necrotising granulomatous inflammation, suggestive of scar sarcoidosis. The lesion re-appeared one year after initial treatment, and was treated with intralesional depot steroids, showing adequate progression. This disease occurs more frequently in wound areas where there are foreign bodies and could be the first sign of systemic sarcoidosis.
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Affiliation(s)
- L Díaz-Cabanas
- Departamento de Oftalmología, Hospital Clínico Universitario, Valladolid, España.
| | - M Belani-Raju
- Departamento de Oftalmología, Hospital Universitario Río Hortega, Valladolid, España
| | - P I González-Márquez
- Servicio de Anatomía Patológica, Hospital Universitario Río Hortega, Valladolid, España
| | - S Artioli-Schellini
- Departamento de Oftalmología, Faculdade de Medicina de Botucatu - UNESP, São Paulo, Brazil
| | - I Guereñu-Panero
- Servicio de Anatomía Patológica, Hospital Universitario Río Hortega, Valladolid, España
| | - A Galindo-Ferreiro
- Departamento de Oftalmología, Hospital Universitario Río Hortega, Valladolid, España
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22
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Yang Y, Cheng Y, Wang C. Concomitant pulmonary sarcoidosis and HIV infection: A case report. Medicine (Baltimore) 2019; 98:e16210. [PMID: 31261572 PMCID: PMC6617437 DOI: 10.1097/md.0000000000016210] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Sarcoidosis is an immune-mediated systemic disease, and the increase in CD4+ T lymphocyte cells is considered as a key factor for the development of sarcoidosis. The acquired immune deficiency syndrome (AIDS) is well known as the impaired immune system and characterized by relative lack of CD4+ T lymphocytes. Thus, the coexistence of sarcoidosis and HIV infection has rarely been reported. PATIENT CONCERNS A 65-year-old female patient was admitted to our respiratory ward complained of fatigue, chest distress, and a persistent dry cough for 2 months. DIAGNOSES The chest computed tomography scan showed diffuse reticulonodular infiltrates and mediastinal and hilar lymphadenopathy. Fibreoptic bronchoscopy along with transbronchial biopsy and transbronchial needle aspiration was performed. The pathological findings revealed noncaseating granulomas, and the patient was found to be HIV-seropositive through enzyme-linked immunosorbent assay and confirmed as HIV by the centers for disease control and prevention. INTERVENTIONS The patient was administered oral methylprednisolone 20 mg/day for pulmonary sarcoidosis and then referred to the hospital for infectious diseases receiving subsequent treatment for HIV. OUTCOMES clinical symptoms relieved 3 months later after treatment. LESSONS The coexistence of sarcoidosis and HIV infection is rare because of paradoxical roles of CD4-positive T cells in the pathogenesis of AIDS and sarcoidosis.
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Affiliation(s)
- Yan Yang
- Department of Respiratory Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang
| | - Yusheng Cheng
- Department of Respiratory Medicine, Yi Ji Shan hospital of Wanna Medical college, Anhui, China
| | - Chenghui Wang
- Department of Respiratory Medicine, Yi Ji Shan hospital of Wanna Medical college, Anhui, China
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23
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Galron E, Grisko O, Zamir D. A Peculiar Case of Abdominal Pain: Clinical Case Education. Isr Med Assoc J 2019; 21:356-361. [PMID: 31140231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ehud Galron
- Department of Internal Medicine D, Barzilai Medical Center, Ashkelon, Israel
| | - Olga Grisko
- Department of Internal Medicine D, Barzilai Medical Center, Ashkelon, Israel
| | - Doron Zamir
- Department of Internal Medicine D, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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24
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Yassari F, Kiani A, Taghavi K, Abdi E, Emami H, Seifi S, Abedini A. Renal Disorders in Pulmonary Sarcoidosis Patients. Iran J Kidney Dis 2019; 13:21-26. [PMID: 30851715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/21/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The frequency of kidney disorders varies in pulmonary sarcoidosis patients. Since the prevalence of kidney disorders among Iranian sarcoidosis patients is uncertain, this study aimed to evaluate kidney disorders and associated manifestations in Iranian pulmonary sarcoidosis patients. MATERIALS AND METHODS One hundred patients with confirmed granuloma as pulmonary sarcoidosis were studied for renal disorders. Size of urinary tract and the presence of renal stones were checked via clinical examination and urinary organ ultrasonography. Patients' 24-hour urine sample was examined for pH, calcium, protein (over 250 mg) and creatinine (over 1.4 mg). RESULTS Thirty-three percent of the patients expressed renal disorders simultaneously.Uric acid in pulmonary sarcoidosis patients could be correlated with the probability of developing renal stone. In addition, 1,25-dihydroxyvitamin D levels above 30 ng/mL and uric acid levels above 7 mg/dL in urine were directly correlated with renal disorders in sarcoidosis patients. CONCLUSIONS Urinalysis is an easy and reliable method for assessing renal disorders in sarcoidosis patients. The current study proposes inclusion of urinalysis in routine checkups of sarcoidosis individuals.
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Affiliation(s)
- Fatemeh Yassari
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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25
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Płusa T. [Differentiation of dyspnea in patients with asthma and lung sarcoidosis]. Pol Merkur Lekarski 2018; 44:110-112. [PMID: 29601558] [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] [Indexed: 06/08/2023]
Abstract
Dyspnea as a subjective feeling of lack of air is the patients with the pathology of the respiratory system. Objectivization of this phenomenon is difficult, despite the introduction of questionnaires about the degree of dyspnoea. The results of these assessments do not always correlate with the results of spirometric tests. In patients with asthma, dyspnoea is caused by airway obstruction. In the case of patients with lung sarcoidosis, the complexity of the phenomenon causes that many mechanisms and factors are responsible for the dyspnea symptoms in these patients. Dyspnea in patients with sarcoidosis is progressive and is closely related to the extent of interstitial exchanges. The diffusion capacity for carbon monoxide (DLco) determined in these patients reflects the degree of respiratory distress. Therapeutic procedures are also dependent on this parameter.
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Affiliation(s)
- Tadeusz Płusa
- Medical Faculty of Łazarski University in Warsaw, Poland
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26
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Jbeli AH, Sunassee A, Sanford A, Elshami A, Bleeker J. A Very Rare Case of Sarcoid-Lymphoma Syndrome Imposing an Intriguing Diagnostic Challenge. S D Med 2018; 71:108-111. [PMID: 29991096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An enigmatic association between sarcoidosis and lymphoma has been proposed in the past. This poses a significant diagnostic challenge, especially when the time interval is less than one year between the two diagnoses. A 54-year-old male patient presented to his primary care physician with worsening acute kidney injury and hypercalcemia. His chest x-ray showed bilateral interstitial nodular thickening and mild bilateral hilar fullness. After a diagnostic workup, the patient was diagnosed with sarcoidosis and started on prednisone. He initially improved, but returned with acute kidney injury, hypercalcemia, and generalized lymphadenopathy. An excisional lymph node biopsy was positive for diffuse large B-cell lymphoma. Our case illustrates the sarcoidosis-lymphoma syndrome. Although there is no recommendation to screen patients with sarcoidosis for malignancy, it is crucial to be aware of this association and to evaluate any new or enlarging lymphadenopathy with a biopsy. It is essential to assess response to prednisone in patients with sarcoidosis.
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Affiliation(s)
- Aiham H Jbeli
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Ashwyna Sunassee
- Department of Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Amy Sanford
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Sanford USD Medical Center, Sioux Falls, South Dakota
| | - Ashraf Elshami
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Sanford USD Medical Center, Sioux Falls, South Dakota
| | - Jonathan Bleeker
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Sanford USD Medical Center, Sioux Falls, South Dakota
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Abstract
OBJECTIVES Sarcoidosis is a multisystem disease characterised by the formation of granulomas within various organs, mainly the lungs. Several studies from different countries have been undertaken to investigate sarcoidosis with extrapulmonary involvement except from China. The objective of this study is to investigate a comparative clinical analysis in patients with pulmonary sarcoidosis with and without extrapulmonary involvement from China. METHODS Data from inpatients diagnosed with sarcoidosis at Shanghai Pulmonary Hospital (Shanghai, China) between January 2009 and December 2014 were retrospectively collected and analysed. Six hundred and thirty-six patients with biopsy-proven sarcoidosis were included in the study, including 378 isolated pulmonary sarcoidosis and 258 pulmonary sarcoidosis plus extrapulmonary involvement. RESULTS Two hundred and fifty-eight (40.6%) patients with pulmonary sarcoidosis had extrapulmonary involvement. Extrapulmonary localisations were detected mostly in extrathoracic lymph nodes (n=147) and skin (n=86). Statistically significant differences were demonstrated between patients with pulmonary sarcoidosis plus extrapulmonary involvement and patients with isolated pulmonary sarcoidosis for fatigue (16.6%vs8.3%, P<0.05), serum ACE (SACE) levels (79.0±46.9 IU/L vs 69.7±38.7 IU/L, P<0.05), and high-resolution CT (HRCT) findings (53.8%vs46.2%, P<0.05). CONCLUSIONS Extrapulmonary involvement is common in patients with pulmonary sarcoidosis, with the most common sites being extrathoracic lymph nodes and skin. Patients with sarcoidosis with extrapulmonary involvement are more symptomatic (fatigue), have higher SACE levels and more deteriorating HRCT findings, to which clinicians should pay attention.
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Affiliation(s)
- Cheng-Wei Li
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou, China
| | - Ru-Jia Tao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dan-Feng Zou
- Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Man-Hui Li
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xin Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei-Jun Cao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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28
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Lannin U, Hayes J. An Unusual Presentation of Sarcoidosis. Ir Med J 2017; 110:668. [PMID: 29372953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bilateral pleural effusions are a rare manifestation of sarcoidosis. We describe here the case of a 30 year old Vietnamese man living in Ireland who presented with a 4 month history of cough, dyspnoea on exertion and fatigue. On chest CT, he was found to have bilateral pleural effusions, bihilar lymphadenopathy and multiple pulmonary nodules. Pleural biopsy confirmed the presence of non caseating granulomas. He was commenced on steroids with excellent clinical response.
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Affiliation(s)
- U Lannin
- Department of Emergency Medicine, Our Lady'sChildren's Hospital Crumlin
| | - J Hayes
- Department of Emergency Medicine, Our Lady'sChildren's Hospital Crumlin
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Błaut-Jurkowska J, Knap K, Kaźnica-Wiatr M, Żygadło A, Tomkiewicz-Pająk L, Podolec P, Olszowska M. [Exercise capacity in patients with pulmonary sarcoidosis]. Pol Merkur Lekarski 2017; 43:61-65. [PMID: 28875971] [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] [Indexed: 06/07/2023]
Abstract
UNLABELLED Exertional dyspnea is a common manifestation of sarcoidosis. Cardiopulmonary exercise testing (CPET) is a useful tool to evaluate exercise tolerance of sarcoid patients. AIM The aim of the study was to evaluate of exercise capacity in patients with pulmonary sarcoidosis with regard to duration of the disease. Analysis of differences in physical tolerance between patients with cardiac sarcoidosis and without cardiac sarcoidosis. MATERIALS AND METHODS 39 patients diagnosed with pulmonary sarcoidosis were enrolled to our study. Cardiopulmonary exercise test was used to assess exercise capacity. According to time passed from diagnosis of sarcoidosis patients were grouped into 2 groups. Cardiac sarcoidosis was diagnosed in 9 subjects (23.07%). The control group consisted of 33 healthy volunteers. RESULTS The results of the ergospirometry test in patients with lung sarcoidosis showed statistically significant differences in comparison to the control group. The age of patients with pulmonary sarcoidosis correlated negatively with maximal heart rate, oxygen consumption at peak exercise and at anaerobic threshold, breathing frequency at peak exercise, minute ventilation at peak exercise and metabolic equivalent. There was a negative, statistically significant correlation between the oxygen pulse at the peak of exercise and the treatment of steroids in the past. CONCLUSIONS Exercise limitation in patients with pulmonary sarcoidosis is a consequence of both ventilatory and cardiocirculatory impairment. Patients with longer disease history of sarcoidosis achieved worse results at cardiopulmonary exercise test than patients with shorter disease history. Trend towards worse exercise tolerance in patients with cardiac sarcoidosis compared to patients without cardiac sarcoidosis was observed.
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Affiliation(s)
- Justyna Błaut-Jurkowska
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Cracow, Poland
| | - Klaudia Knap
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Cracow, Poland
| | - Magdalena Kaźnica-Wiatr
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Cracow, Poland
| | - Agnieszka Żygadło
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Cracow, Poland
| | - Lidia Tomkiewicz-Pająk
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Cracow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Cracow, Poland
| | - Maria Olszowska
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Cracow, Poland
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Gaucher S, Nicolas C, Piveteau O, Philippe HJ, Blanche P. Sarcoidosis and Wound Healing After Cellulitis of the Lower Limb: Is Methotrexate Responsible for Skin Graft Failure? Wounds 2017; 29:229-230. [PMID: 28862976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The authors report the case of a 53-year-old man with diffuse cutaneous and mediastinal pulmonary sarcoidosis and well-controlled steroid-induced diabetes. He was hospitalized for cellulitis of his left leg. His standard treatment for sarcoidosis consisted of prednisone and methotrexate. Prednisone was stopped at his admission. He received antibiotics for 4 weeks to treat the cellulitis. In parallel, the leg wound was treated with daily silver sulfadiazine applications until necrosis removal, then by skin autografting. Four successive procedures were performed, but all failed despite lack of surgical problem or local infection. Methotrexate was stopped after the fourth grafting procedure failed; the fifth, and final, autografting procedure was successfully performed.
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Affiliation(s)
- Sonia Gaucher
- Faculté de Médecine, Paris Descartes, Paris, France and Service de Chirurgie Générale, Plastique et Ambulatoire, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, France
| | - Claire Nicolas
- Service de Soins de Suite et Rééducation, Coubert, France
| | - Olivier Piveteau
- Service de Chirurgie Générale, Plastique et Ambulatoire, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, France
| | - Henri-Jean Philippe
- Faculté de Médecine, Paris Descartes, Paris, France and Service de Chirurgie Générale, Plastique et Ambulatoire, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, France
| | - Philippe Blanche
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
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Bustamente L, Buscot M, Marquette CH, Roux C. Sarcoidosis and tocilizumab: is there a link? Clin Exp Rheumatol 2017; 35:716. [PMID: 28516883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/09/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Lindsay Bustamente
- Rheumatology Department, LAHMESS laboratory, University of Nice Sophia-Antipolis, Hôpital Pasteur 2, Nice, France
| | - Matthieu Buscot
- UMR E-4320 TIRO-MATOs CEA/iBEB, University of Nice Sophia-Antipolis, Faculté de Médecine Nice, France
| | - Charles-Hugo Marquette
- Pneumology Department, University of Nice Sophia-Antipolis, Hôpital Pasteur 1, Nice, France
| | - Christian Roux
- Rheumatology Department, LAHMESS laboratory, University of Nice Sophia-Antipolis, Hôpital Pasteur 2, Nice, France.
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Mirsaeidi M, Omar HR, Baughman R, Machado R, Sweiss N. The association between BNP, 6MWD test, DLCO% and pulmonary hypertension in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:317-320. [PMID: 28079843] [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: 11/08/2015] [Accepted: 03/14/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a feared complication in patients with sarcoidosis.It is an important negative prognostic factor which is reflected as a priority given to these subjects for orthotopic lung transplantation. We evaluated the relationship between BNP, 6MWD test, DLCO% values and the severity of sarcoidosis-associated pulmonary hypertension. METHODS A retrospective chart review was conducted between January 2010 and January 2015 on consecutive confirmed adult subjects diagnosed with sarcoidosis. Demographics, medical comorbidities, clinical features, pulmonary function tests (PFTs), 6MWD test, transthoracic echocardiography, laboratory investigations, radiographic findings, treatment and outcome data were collected from medical records. Subjects with suspicion for PH (i.e. those with PASP ≥ 25 mmHg) were included in the study. PH severity was classified using PASP into mild (PASP 25-49 mmHg), moderate (50-69 mmHg) and severe (≥70 mmHg). We evaluated the strength of correlation between BNP, 6MWD test, DLCO% and the severity of PH. The association between variables was performed using Pearson correlation coefficient and results were considered statistically significant if P value was <0.05. RESULTS Among the 108 cases diagnosed with sarcoidosis, we identified a total of 27 patients (25%) who had an elevated PASP suggestive of PH and met the study inclusion criteria. There was a significant correlation between BNP level (r=0.804, P=0.003), 6MWD test (r=-0.865, P=0.000), DLCO% (r=-0.513, P=0.015) and the PASP in sarcoidosis patients. CONCLUSION Although these simple tests should not be used as screening tools for suspecting sarcoidosis-associated pulmonary hypertension, they may be of value in following its progression in subjects already diagnosed with pulmonary hypertension.
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Rosenstein R, Orme C, Kim RH, Meehan SA, Femia A. Sarcoidosis with prominent necrosis on histopathology. Dermatol Online J 2016; 22:13030/qt0t5336w4. [PMID: 28329548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
Sarcoidosis is a multiorgan inflammatory diseasewith variable clinical presentations and the commonhistopathologic finding of noncaseating granulomas.The etiology of the disease is not known, butevidence suggests both environmental and geneticcontributions to the pathogenesis. Depending onthe severity of cutaneous disease and extent ofextracutaneous involvement, therapies range fromtopical and intralesional glucocorticoids to systemicimmunomodulatory and immunosuppressiveagents. We present the case of a patient withcutaneous sarcoidosis with prominent necrosis onhistopathologic examination in the setting of severepulmonary sarcoidosis.
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Affiliation(s)
- Rachel Rosenstein
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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Ota H, Sugino K, Uekusa T, Takemura T, Homma S. An autopsy case of refractory pulmonary hypertension with sarcoidosis. Respir Investig 2016; 54:490-493. [PMID: 27886864 DOI: 10.1016/j.resinv.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/11/2015] [Revised: 12/24/2015] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
A 63-year-old man with sarcoidosis-associated pulmonary hypertension (SAPH) died suddenly of decompensated right heart failure. At autopsy, microscopy showed subpleural and interlobular fibrosis in both upper lobes, with marked broncho-bronchiolectasis, as well as bronchovascular bundle fibrosis and fibrotic organization in alveolar lumens, which are consistent with pulmonary sarcoidosis. Intimal fibrosis and medial hypertrophy were noted in the proximal elastic to distal muscular pulmonary arteries (Heath-Edwards, grades II-III) within intensive fibrotic lesions. Additionally, diffuse alveolar capillary multiplication (DACM) was present in macroscopically normal lung parenchymal lesions, associated with wall muscularization. In this case, muscularization of capillaries may have been induced by hypoxemia and hypoxic pulmonary vasoconstriction, resulting in pulmonary hypertension.
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Affiliation(s)
- Hiroki Ota
- Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
| | - Toshimasa Uekusa
- Department of Pathology, Labor Health and Welfare Organization Kanto Rosai Hospital, Kawasaki, Japan.
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan.
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
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Condado JF, Babaliaros V, Henry TS, Kaebnick B, Kim D, Staton GW. Pulmonary stenting for the treatment of sarcoid induced pulmonary vascular stenosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:281-287. [PMID: 27758995] [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: 07/30/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The best treatment of patients with external pulmonary vascular compression due to advanced sarcoidosis is unknown. OBJECTIVES To report a single-center experience of percutaneous treatment for pulmonary vascular stenosis caused by external compression due to advanced sarcoidosis. METHODS We report a case series of 5 patients with biopsy confirmed advanced sarcoidosis, seen at our academic institution with worsening dyspnea despite increase of immunosuppressive therapy. All patients were evaluated by a multidisciplinary team (cardiology, pulmonary and radiology) using a multi-modality approach, including chest-computed tomography angiography, ventilation/perfusion scintigraphy, pulmonary function test, 6-minute walk test and heart catheterization. RESULTS Three out of five patients underwent pulmonary artery or vein angioplasty and stenting resulting in symptomatic improvement: Patient 1 had persistent symptomatic improvement measured by subjective and objective methods at 30 months; patient 2 required re-intervention due to recurrent pulmonary vein stenosis at 6-months followed by persistent improvement; and patient 3, had a procedure complicated with in-stent thrombosis requiring thrombolysis and anticoagulation with improvement. The remaining two patients were medically treated because underlying thromboembolic disease (patient 4) and diffuse pulmonary vein stenosis not amenable to percutaneous intervention (patient 5). CONCLUSIONS Pulmonary vascular stenosis from external compression can be a rare but unrecognized caused of worsening symptoms in advanced sarcoidosis. Pulmonary vascular angioplasty and stenting can provide clinical benefit in select patients.
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Hu X, Carmona EM, Yi ES, Pellikka PA, Ryu J. Causes of death in patients with chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:275-280. [PMID: 27758994] [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: 07/26/2015] [Accepted: 01/11/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Sarcoidosis is a multi-system, granulomatous disorder of unknown etiology that is associated with a variable prognosis and sometimes results in death. There are conflicting reports regarding the causes of death in patients with sarcoidosis. METHODS Forty-four consecutive patients with sarcoidosis who underwent an autopsy (35 patients) or died at Mayo Clinic (Rochester, MN, USA) over a 20-yr period, from January 1, 1994 to December 31, 2013 were analyzed. RESULTS The median age at death was 63 years (range, 33-94 years) and there were 22 (50%) women. Sarcoidosis had not been clinically diagnosed in 16 (36%) patients before death. Fifteen deaths (34%) were related to sarcoidosis and included seven deaths (16%) from cardiac sarcoidosis and four deaths (9%) from progressive pulmonary sarcoidosis. Other sarcoidosis-related causes of death included advanced hepatic sarcoidosis (5%) and opportunistic infections (5%) related to immunosuppressive therapy for treating sarcoidosis. Among seven patients dying from cardiac sarcoidosis, three had been diagnosed with sarcoidosis during life and cardiac involvement was known in two of them. Six of seven deaths from cardiac sarcoidosis occurred in the autopsied cohort while all four deaths from pulmonary sarcoidosis occurred in those not autopsied. CONCLUSIONS In the majority of patients dying with sarcoidosis the cause of death is unrelated to sarcoidosis. Cardiac involvement is the most common cause of sarcoidosis-related deaths in patients subjected to postmortem examination and was usually undiagnosed during life. The cause distribution of death in patients with sarcoidosis differed depending on whether autopsy was performed.
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Ungprasert P, Crowson CS, Matteson EL. Influence of Gender on Epidemiology and Clinical Manifestations of Sarcoidosis: A Population-Based Retrospective Cohort Study 1976-2013. Lung 2016; 195:87-91. [PMID: 27709291 DOI: 10.1007/s00408-016-9952-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/01/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE The influence of ethnicity on epidemiology and clinical manifestations of sarcoidosis is well recognized. However, data on the role of sex are limited. METHODS The current study utilized the resource of the Rochester Epidemiology Project to identify all residents of Olmsted County, Minnesota, United States, with new diagnosis of sarcoidosis from 1976 to 2013. Diagnosis was verified by medical record and histopathological report review. RESULTS 345 incident cases of sarcoidosis were identified: 174 (50 %) were female and 171 (50 %) were male. The age at diagnosis was significantly higher among females than males (48.3 vs. 42.8 years; p < 0.001). Intra-thoracic disease was seen in the great majority of patients (98 % among females and 96 % among males; p = 0.50). However, pulmonary symptoms were significantly more frequent among males than females (51 vs. 36 %; p = 0.006). The frequency of individual extra-thoracic organ involvement was not significantly different between females and males except for cutaneous involvement and uveitis that were significantly more common among females (6 vs. 1 % for uveitis, p = 0.012 and 25 vs. 12 % for cutaneous involvement, p = 0.002). The frequency of elevate angiotensin-converting enzyme level and hypercalcemia was not significantly different between the two sexes. CONCLUSIONS Females tended to be older at the age they developed sarcoidosis, and had more uveitis and cutaneous involvement than males.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First avenue SW, Rochester, MN, 55905, USA.
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First avenue SW, Rochester, MN, 55905, USA
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First avenue SW, Rochester, MN, 55905, USA
- Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN, 55905, USA
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Konno T, Shimizu M, Ino H, Araki T, Yamaguchi M, Inoue M, Tofuku Y, Mabuchi H. A Rare Type of Alternating Bundle Branch Block in a Patient with Cardiac Sarcoidosis. Angiology 2016; 56:115-7. [PMID: 15678266 DOI: 10.1177/000331970505600117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report a rare type of alternating bundle branch block observed in a patient with cardiac sarcoidosis. Not only alternation of complete right and left bundle branch block but also narrow QRS complexes were observed on electrocardiogram. The mechanism of these unusual findings is briefly discussed.
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MESH Headings
- Adult
- Bundle-Branch Block/diagnosis
- Bundle-Branch Block/etiology
- Bundle-Branch Block/therapy
- Cardiomyopathies/complications
- Cardiomyopathies/diagnosis
- Diagnosis, Differential
- Diagnostic Imaging
- Electrocardiography
- Heart Block/diagnosis
- Heart Block/etiology
- Heart Block/therapy
- Humans
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/therapy
- Male
- Pacemaker, Artificial
- Sarcoidosis/complications
- Sarcoidosis/diagnosis
- Sarcoidosis, Pulmonary/complications
- Sarcoidosis, Pulmonary/diagnosis
- Syncope/etiology
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/therapy
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Affiliation(s)
- Tetsuo Konno
- Molecular Genetics of Cardiovascular Disorders, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
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Aggarwal AN, Sahu KK, Gupta D. Fatigue and health-related quality of life in patients with pulmonary sarcoidosis treated by oral Corticosteroids. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:124-129. [PMID: 27537714] [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: 05/02/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND It is not clear how well sarcoidosis-associated fatigue improves with definitive therapy. OBJECTIVE To evaluate improvement in fatigue in patients of sarcoidosis receiving oral corticosteroid therapy, and correlate it with clinical recovery and change in health-related quality of life (HRQL). METHODS We studied 51 newly diagnosed adult patients of pulmonary sarcoidosis. Sarcoidosis Health questionnaire (SHQ) was used to assess HRQL. Fatigue was evaluated using Fatigue Assessment Scale (FAS). All patients received six month treatment with oral prednisolone, and SHQ and FAS were administered before initiation and after completion of treatment. Baseline and post-treatment scores were compared and a 4-point change in FAS scores considered clinically significant. RESULTS All patients improved clinically and radiologically with therapy. Body aches, however, persisted in 12 of 28 (42.9%) patients having this symptom at baseline. 33 patients (64.7%) had pre-treatment fatigue (FAS >=22), of which seven (13.7%) were severely fatigued (FAS score >=35). Of them 21 (63.6%) and 4 (12.1%) patients respectively showed improvement and deterioration in FAS score by >4 points. Only five of 18 patients with baseline FAS score <22 also showed >4 point score increment after treatment, and four of them developed fatigue during therapy. All patients with baseline severe fatigue improved. Overall, FAS scores, and all SHQ domain scores, significantly improved with treatment. CONCLUSIONS Both fatigue as well as HRQL improved significantly, and largely parallelly, with treatment for sarcoidosis. Persistence of fatigue, or new onset fatigue, may be encountered during treatment, possibly as an adverse effect of corticosteroid therapy.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh.
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Ucsular F, Karadeniz G, Karadeniz C, Yalnız E, Demir M. Evaluation of Tpeak-Tend interval and Tpeak-end/QT ratio in patients with Sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:151-156. [PMID: 27537718] [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: 07/12/2015] [Accepted: 01/22/2016] [Indexed: 06/06/2023]
Abstract
UNLABELLED rdiogram (ECG), can be used as a marker of transmural dispersion of repolarization. Also, Tp-e/QT and Tp-e/QTc ratios are used as an index of arrhythmogenesis. Prolonged Tp-e interval and Tp-e/QT ratio was found associated with sudden cardiac death in different clinical conditions. Novel ventricular repolarization parameters, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios have not been evaluated in patients with sarcoidosis without cardiac symptoms previously.Therefore, we investigated Tp-e interval in patients with pulmonary sarcoidosis. METHODS Sixty-one consecutive patients diagnosed with biopsy-proven pulmonary sarcoidosis were retrospectively reviewed. The 12-lead ECG examinations were performed at speed of 25 mm/s while the patients were in supine position. QT dispersion, Tp-e intervals and Tp-e/QT ratio were measured. RESULTS Comparison of ECG parameters between two groups showed a significantly higher average heart rate (p< 0.05) in the patients with sarcoidosis than controls. QT dispersion was higher in patients group. Tp-e interval was significantly prolonged in the study group compared to the control group (92±21 ms and 85±14 ms, respectively; p< 0.05). Tp-e/QT and Tp-e/QTc ratios were significantly higher in patients with sarcoidosis compared to control subjects (all p values < 0.05). CONCLUSIONS The novel repolarization parameters Tp-e interval, Tp-e/QT and Tp-e/QTc ratios are increased in patients with sarcoidosis without any cardiac symptoms. These parameters might be used as a marker for predicting the ventricular arrhythmias and sudden cardiac death in patients with sarcoidosis.
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Atkins CP, Gilbert D, Brockwell C, Robinson S, Wilson AM. Fatigue in sarcoidosis and idiopathic pulmonary fibrosis: differences in character and severity between diseases. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:130-138. [PMID: 27537715] [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] [Grants] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/25/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sarcoidosis and idiopathic pulmonary fibrosis (IPF) are two common forms of interstitial lung disease. Fatigue is a recognised feature of sarcoidosis but an association between IPF and fatigue has not been investigated. RATIONALE To investigate the frequency and severity of fatigue in these groups, and variables affecting fatigue scores. METHODS A cross-sectional questionnaire study of patients with sarcoidosis and IPF followed-up at a single hospital was undertaken. Questionnaire data included validated measures of fatigue, anxiety, depression, sleepiness and dyspnoea, plus measures of disease severity including spirometry data. RESULTS Questionnaires were administered to 232 patients (82 healthy volunteers, 73 sarcoidosis patients and 77 IPF patients). Sarcoidosis patients had statistically higher sleepiness scores but no significant difference was seen between overall measures of fatigue, anxiety or depression. Stratification by severity revealed a non-statistically significant tendency towards more severe fatigue scores in sarcoidosis. Regression analysis failed to identify any significant predictor variables measured in the sarcoidosis cohort, though in the IPF group both dyspnoea and sleepiness scores were significant predictors of fatigue (R2=0.74). CONCLUSIONS Both sarcoidosis and IPF patients suffer with fatigue, although sarcoidosis patients tended towards reporting more severe fatigue scores, suggesting a subgroup with severe fatigue. The fatigue experienced by the two groups appears to be different; sarcoidosis patients report greater frequency of mental fatigue whereas IPF patients appear to suffer exhaustion, potentially related to dyspnoea. Dyspnoea and sleepiness scores modeled the majority of fatigue in the IPF group, whereas no single factor was able to predict fatigue in sarcoidosis.
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Martusewicz-Boros MM, Piotrowska-Kownacka D, Wiatr E, Roszkowski-Śliż K. Cardiac sarcoidosis - silent destroyer. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:175-177. [PMID: 27537722] [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: 07/23/2015] [Revised: 01/18/2016] [Accepted: 01/07/2016] [Indexed: 06/06/2023]
Abstract
We report a case of histologically proven pulmonary sarcoidosis and cardiac involvement in a 53-year old woman with progression leading to the heart failure documented in cardiovascular magnetic resonsnce studies.
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Abstract
BACKGROUND Cryptococcal meningitis is an uncommon but severe complication of sarcoidosis. METHODS We present 2 patients with cryptococcal meningitis complicating sarcoidosis and compared findings with 38 cases reported in the literature. RESULTS When analyzing our patients and 38 cases reported in the literature, we found that median age of sarcoidosis patients with cryptococcal meningitis was 39 years (range 30-48); 27 of 33 reported cases (82%) had a history of sarcoidosis. Only 16 of 40 patients (40%) received immunomodulating therapy at the time of diagnosis of cryptococcal meningitis. The diagnosis of cryptococcal meningitis was delayed in 17 of 40 patients (43%), mainly because of the initial suspicion of neurosarcoidosis. Cerebrospinal fluid (CSF) examination showed mildly elevated white blood cell count (range 23-129/mm). Twenty-nine of 32 cases (91%) had a positive CSF culture for Cryptococcus neoformans and 25 of 27 cases (93%) had a positive CSF C neoformans antigen test. CD4 counts were low in all patients in whom counts were performed (84-228/mL). Twelve patients had an unfavorable outcome (32%), of which 7 died (19%) and 24 patients (65%) had a favorable outcome. The rate of unfavorable outcome in patients with a delayed diagnosis was 7 of 17 (41%) compared to 5 of 28 (21%) in patients in whom diagnosis was not delayed. CONCLUSION Cryptococcal meningitis is a rare but life-threatening complication of sarcoidosis. Patients were often initially misdiagnosed as neurosarcoidosis, which resulted in considerable treatment delay and worse outcome. CSF cryptococcal antigen tests are advised in patients with sarcoidosis and meningitis.
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Affiliation(s)
| | | | | | - Matthijs C. Brouwer
- Department of Neurology, Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands
- Correspondence: Matthijs C. Brouwer, Department of Neurology, Academic Medical Centre, University of Amsterdam, the Netherlands (e-mail: )
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Goldbach H, Wanat K, Rosenbach M. Multiple eruptive dermatofibromas in a patient with sarcoidosis. Cutis 2016; 98:E15-E19. [PMID: 27622262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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45
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Wang-Buholzer C, Nicod L. [Not Available]. Rev Med Suisse 2016; 12:902-903. [PMID: 27323485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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46
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Boerner EB, Costabel U, Wessendorf TE, Theegarten D, Hetzel M, Drent M, Bonella F. Pulmonary alveolar proteinosis: another autoimmune disease associated with sarcoidosis? Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:90-94. [PMID: 27055841] [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: 02/21/2015] [Accepted: 04/22/2015] [Indexed: 06/05/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by the accumulation of surfactant phospholipids and lipoproteins within the alveoli. Here we report on a female patient who was diagnosed with autoimmune PAP and successfully treated with whole lung lavage (WLL). 15 months after PAP diagnosis the patient developed marked fatigue. Additional tests revealed the diagnosis of sarcoidosis. We can only speculate that PAP and sarcoidosis in our patient are linked to each other based on the fact that other autoimmune disorders have also been associated with sarcoidosis.
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Affiliation(s)
- Eda Burcu Boerner
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, University Duisburg-Essen.
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Bindoli S, Dagan A, Torres-Ruiz JJ, Perricone C, Bizjak M, Doria A, Shoenfeld Y. Sarcoidosis and Autoimmunity: From Genetic Background to Environmental Factors. Isr Med Assoc J 2016; 18:197-202. [PMID: 27228643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sarcoidosis is a chronic multisystem disease with variable course resulting from the interaction between environmental factors and the immune system of individuals genetically predisposed. The evidence linking sarcoidosis with environmental triggers such as metals is increasing. We describe the case of a 44 year old female with a history. of smoking since age 30 and previous mercury dental filling who presented at physical examination with numerous subcutaneous nodules. Laboratory data showed accelerated erythrocyte sedimentation rate and high titer of anti-U1 ribonucleoprotein antibodies (U1 RNP). Skin biopsy and chest X-ray suggested the diagnosis of sarcoidosis. In this report we illustrate the different causes involved in the onset of sarcoidosis.
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48
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Wang'ondu RW, Long T. An Atypical Case of Hemoptysis. Conn Med 2016; 80:153-157. [PMID: 27169298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hemoptysis, a common sign of diffuse alveolar hemorrhage, can be caused by multiple factors, both infectious and noninfectious. A 45-year-old male with hypertension, obstructive sleep apnea, and stage IV pulmonary sarcoidosis with cardiac involvement, presented with a two-month history of cough and acute nonmassive hemoptysis with hypoxia. A chest CT showed ground glass consolidation and interlobular septal thickening, concerning for diffuse alveolar hemorrhage. Flexible bronchoscopy confirmed diffuse alveolar hemorrhage; microbiological analyses of bronchoalveolar washings did not reveal a causative organism. Mycoplasma pneumoniae-specific IgM in serum studies was consistent with mycoplasma pneumonia as the most likely etiology of this patient's diffuse alveolar hemorrhage and resultant hemoptysis. This report points to the need to consider atypical mycoplasma pneumonia as a possible etiology of hemoptysis in patients with underlying sarcoidosis.
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Pizarro C, Goebel A, Dabir D, Hammerstingl C, Pabst S, Grohé C, Fimmers R, Stoffel-Wagner B, Nickenig G, Schild H, Skowasch D, Thomas D. Cardiovascular magnetic resonance-guided diagnosis of cardiac affection in a Caucasian sarcoidosis population. Sarcoidosis Vasc Diffuse Lung Dis 2016; 32:325-335. [PMID: 26847100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Clinically evidenced cardiac involvement in systemic sarcoidosis occurs in approximately 5% of patients, whereas post-mortem examinations identify cardiac sarcoidosis in over 60% of cases. OBJECTIVE Given the inconsistency of diagnostic approaches, we took aim at prospectively investigating the prevalence of cardiac sarcoidosis by cardiovascular magnetic resonance (CMR) in a primary Caucasian population and at correlating the results with standard clinical parameters. METHODS 188 patients with histologically proven sarcoidosis were included, provenient from the local pneumological department and a national sarcoidosis self-help association. All of them underwent CMR-imaging. Complementary 12-lead ECG, Holter monitoring, laboratory and pulmonary function testing were performed. RESULTS CMR-based diagnosis of cardiac sarcoidosis was made in 29 patients (15.4%), of whom 17 patients (9% of total cohort) exhibited increased relative gadolinium enhancement - reflecting acute inflammatory processes -, while 11 patients (5.9% of total cohort) showed late gadolinium enhancement as a marker for nonviable tissue damage. Both abnormalities were present in 1 patient (0.5%). Correlation analysis evinced significant association between CMR-diagnosed cardiac sarcoidosis and reduction in LVEF, increase in diastolic interventricular septal thickness, diastolic dysfunction as well as limited electrocardiographic abnormalities. Neither laboratory values nor pulmonary function parameters correlated with presence or activity of cardiac sarcoidosis. CONCLUSIONS Among our predominantly Caucasian sarcoidosis study population, CMR-detected cardiac affection occurred in 15.4% and was missed by internationally valid standard clinical testing in all but one case. It reinforces CMR's diagnostic value as modality of choice to evaluate cardiac sarcoidosis. The estimation of its prognostic potential and its value in assessing the incidence of cardiac sarcoidosis however requires further longitudinal investigation.
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Affiliation(s)
- Carmen Pizarro
- University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany.
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Godziszewska S, Widuchowska M, Kopeć-Mędrek M, Kucharz EJ. Coexistence of systemic sclerosis and sarcoidosis. Wiad Lek 2016; 69:693-694. [PMID: 27941212] [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] [Indexed: 06/06/2023]
Abstract
Coexistence of systemic sclerosis (SSc) and sarcoidosis (SA) is rarely reported; 21 cases only were reported in the English medical literature before 2011. It is suggested that low incidence of overlap syndrome of SSc with SA is resulted from different immune mechanisms involved in pathogenesis of the diseases. In SSc patients, a role of Th2 lymphocytes is suggested while in patients with SA such role is attributed to Th1 lymphocytes. The paper presents a 47-year-old woman suffering from SSc for over 6 years. CT scan of the lungs revealed the nodulus of the right lung and enlarged mediastinal lymphatic nodes. Pathologic evaluation of the nodulus provided basis for diagnosis of sarcoidosis. Diagnosis of SSc was based on clinical and capilaroscopic evaluation as well as detection of anti-topoisomerase I antibodies. In the course of the disease, fibrosis of the lung, pulmonary hypertension and cardiac abnormalities with rhythm disturbances were developed. Treatment included cyclophosphamide, mycophenolate mofetil, sildenafil, losartan. Stabilization of the general state of the patient was achieved.
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MESH Headings
- Antibodies, Antinuclear/blood
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/etiology
- Cyclophosphamide/therapeutic use
- Drug Therapy, Combination
- Female
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/etiology
- Losartan/therapeutic use
- Microscopic Angioscopy
- Middle Aged
- Mycophenolic Acid/therapeutic use
- Sarcoidosis, Pulmonary/complications
- Sarcoidosis, Pulmonary/drug therapy
- Scleroderma, Systemic/blood
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Sildenafil Citrate/therapeutic use
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Affiliation(s)
- Sabina Godziszewska
- Department of Internal Medicine, Subdivision of Gastrology, Medical Center, Jaworzno, Poland
| | - Małgorzata Widuchowska
- Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland
| | - Magdalena Kopeć-Mędrek
- Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland
| | - Eugeniusz Józef Kucharz
- Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland, e-mail:
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