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Gadelha A, Yonamine CM, Nering M, Rizzo LB, Noto C, Cogo-Moreira H, Teixeira AL, Bressan R, Maes M, Brietzke E, Hayashi MAF. Angiotensin converting enzyme activity is positively associated with IL-17a levels in patients with schizophrenia. Psychiatry Res 2015; 229:702-7. [PMID: 26296754 DOI: 10.1016/j.psychres.2015.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/17/2015] [Accepted: 08/11/2015] [Indexed: 01/07/2023]
Abstract
Previous studies of our group showed increased plasmatic Angiotensin-I Converting Enzyme (ACE) activity in schizophrenia (SCZ) patients compared to healthy controls, which was also associated to poor cognitive functioning. The ACE main product angiotensin II (Ang-II) has pro-inflammatory properties. Activated immune-inflammatory responses in SCZ and their association with disease progression and cognitive impairments are also well-described. Therefore, we examined here the association of plasma ACE activity and inflammatory mediators in 33 SCZ patients and 92 healthy controls. Non-parametric correlations were used to investigate the association of the enzyme activity and the peripheral levels of immune inflammatory markers as interleukins, tumor necrosis factor (TNF-α), and interferon (IFN-γ). Although no significant correlations could be observed for ACE activity and measured cytokines levels in healthy controls, a significant positive correlation for ACE enzymatic activity and IL-17a levels was observed in SCZ patients. Correcting for gender did not change these results. Moreover, a significant association for ACE activity and IFN-γ levels was also observed. To our knowledge, this is the first study to show a significant association between higher ACE activity and the levels of cytokines, namely IL-17a and IFN-γ, in patients with SCZ.
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Affiliation(s)
- Ary Gadelha
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Schizophrenia Program (ProEsq), Department of Psychiatry, UNIFESP, São Paulo, Brazil.
| | - Camila M Yonamine
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Pharmacology, UNIFESP, São Paulo, Brazil
| | | | - Lucas Bortolotto Rizzo
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Cristiano Noto
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Schizophrenia Program (ProEsq), Department of Psychiatry, UNIFESP, São Paulo, Brazil
| | - Hugo Cogo-Moreira
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Antônio Lúcio Teixeira
- Translational Psychoneuroimmunology Group, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo Bressan
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Schizophrenia Program (ProEsq), Department of Psychiatry, UNIFESP, São Paulo, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; IMPACT Research Center, Deakin University, Geelong, Australia
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Mirian A F Hayashi
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Pharmacology, UNIFESP, São Paulo, Brazil.
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Abstract
Sarcoidosis is a systemic disorder of unknown etiology, which may involve various tissues and organs and is characterized by a noncaseating granuloma reaction. While pathogenesis is not yet clear, cellular immune system activation and nonspecific inflammatory response occur secondarily to several genetic and environmental factors. T helper 1-cells and macrophage-derived pro-inflammatory cytokines stimulate the inflammatory cascade and formation of granuloma occurs as a result of tissue permeability, cell influx, and local cell proliferation. The different prevalence, clinical results, and disease course observed in different races and ethnic groups, is an indicator of the heterogeneous nature of the disease. Sarcoidosis may mimic and/or may occur concomitantly with numerous primary rheumatic diseases. This disease most commonly presents with bilateral hilar lymphadenopathy, pulmonary infiltrations, and skin and eye lesions. Locomotor system involvement is observed at a range of 15% and 25%. Two major joint involvements have been described: acute and chronic form. The most common form, the acute form, may be the first sign of sarcoidosis and present with arthralgia, arthritis, or periarthritis. Chronic sarcoid arthritis is usually associated with pulmonary parenchymal disease or other organ involvement and occurs rarely. While asymptomatic muscular involvement is reported between 25% and 75%, symptomatic muscular involvement is very rare. Symptomatic myopathy may present as three different types: chronic myopathy, palpable nodular myositis, or acute myositis. Even if rare, 2-5% of cases may exhibit osseous involvement and it is frequently associated with lupus pernio, chronic uveitis, and multisystemic disease. Sarcoidosis was reported together with different rheumatologic diseases. There are studies showing that sarcoidosis may mimic the clinical and laboratory findings of these disorders. Nonsteroidal anti-inflammatory drugs and corticosteroids are used for treating the symptoms of rheumatologic findings. In patients who are unresponsive to corticosteroids, immunosuppressive and anti-tumor necrosis factor alpha drugs may be used. In this review, the incidence of rheumatologic symptoms, the clinical findings, and the treatment of rheumatologic manifestations of sarcoidosis are discussed.
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Affiliation(s)
- Senol Kobak
- Associate Professor, Department of Rheumatology, Sifa University Faculty of Medicine, 35100-Bornova, Izmir, Turkey
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153
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Adalimumab for refractory pulmonary sarcoidosis. Ir J Med Sci 2015; 185:969-971. [DOI: 10.1007/s11845-015-1363-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/25/2015] [Indexed: 11/26/2022]
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154
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Systemic Sarcoidosis Presenting with Headache and Stroke-Like Episodes. Case Reports Immunol 2015; 2015:619867. [PMID: 26491579 PMCID: PMC4603591 DOI: 10.1155/2015/619867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/13/2015] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disorder. Neurological manifestations as a presenting symptom are relatively rare. A 26-year-old male presented with a five-week history of headache suggestive of raised intracranial pressure. He subsequently developed transient episodes of mild right-sided hemiparesis and numbness. Magnetic resonance imaging (MRI) of brain revealed widespread inflammatory white matter lesions, an ischaemic focus in the left corona radiata, and widespread microhaemorrhages consistent with a more diffuse vasculopathy. Serum angiotensin-converting enzyme (ACE) level was normal. Lumbar puncture revealed an elevated opening pressure (36 cmH2O) and inflammatory cerebrospinal fluid (CSF). Computerised tomography (CT) of chest, abdomen, and pelvis revealed widespread lymphadenopathy and biopsy of axillary lymph nodes revealed the presence of noncaseating granulomata in keeping with systemic sarcoidosis. The patient responded well to corticosteroids. This case highlights the importance of considering sarcoidosis to be a rare but potentially treatable cause of stroke in younger patients.
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155
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Du SS, Zhao MM, Zhang Y, Zhang P, Hu Y, Wang LS, Zhou Y, Li QH, Li Y, Du YK, He X, Li N, Yin ZF, Wei YR, Weng D, Li HP. Screening for Differentially Expressed Proteins Relevant to the Differential Diagnosis of Sarcoidosis and Tuberculosis. PLoS One 2015; 10:e0132466. [PMID: 26368286 PMCID: PMC4569088 DOI: 10.1371/journal.pone.0132466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/15/2015] [Indexed: 12/30/2022] Open
Abstract
Background In this study, we sought to identify differentially expressed proteins in the serum of patients with sarcoidosis or tuberculosis and to evaluate these proteins as markers for the differential diagnosis of sarcoidosis and sputum-negative tuberculosis. Methods Using protein microarrays, we identified 3 proteins exhibiting differential expression between patients with sarcoidosis and tuberculosis. Elevated expression of these proteins was verified using the enzyme-linked immunosorbent assay (ELISA) and was further confirmed by immunohistochemistry. Receiver operating characteristic (ROC) curve, logistic regression analysis, parallel, and serial tests were used to evaluate the diagnostic efficacy of the proteins. Results Intercellular Adhesion Molecule 1(ICAM-1) and leptin were screened for differentially expressed proteins relevant to sarcoidosis and tuberculosis. Using ROC curves, we found that ICAM-1 (cutoff value: 57740 pg/mL) had an area under the curve (AUC), sensitivity, and specificity of 0.718, 62.3%, and 79.5% respectively, while leptin (cutoff value: 1193.186 pg/mL) had an AUC, sensitivity, and specificity of 0.763, 88.3%, and 65.8%, respectively. Logistic regression analysis revealed that the AUC, sensitivity, and specificity of combined leptin and ICAM-1 were 0.787, 89.6%, and 65.8%, respectively, while those of combined leptin, ICAM-1, and body mass index (BMI) were 0.837, 90.9%, and 64.4%, respectively, which had the greatest diagnostic value. Parallel and serial tests indicated that the BMI-leptin parallel with the ICAM-1 serial was the best diagnostic method, achieving a sensitivity and specificity of 86.5% and 73.1%, respectively. Thus, our results identified elevated expression of ICAM-1 and leptin in serum and granulomas of sarcoidosis patients. Conclusions ICAM-1 and leptin were found to be potential markers for the diagnosis of sarcoidosis and differential diagnosis of sarcoidosis and sputum-negative tuberculosis.
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Affiliation(s)
- Shan-Shan Du
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Meng-Meng Zhao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Chest Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yang Hu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Liu-Sheng Wang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Ying Zhou
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Qiu-Hong Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yan Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yu-Kui Du
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xian He
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Soochow University, School of Medicine, Suzhou, China
| | - Nan Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Zhao-Fang Yin
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Soochow University, School of Medicine, Suzhou, China
| | - Ya-Ru Wei
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Dong Weng
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
- * E-mail: (HPL); (DW)
| | - Hui-Ping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
- * E-mail: (HPL); (DW)
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Crommelin HA, Vorselaars ADM, van Moorsel CHM, Korenromp IHE, Deneer VHM, Grutters JC. Anti-TNF therapeutics for the treatment of sarcoidosis. Immunotherapy 2015; 6:1127-43. [PMID: 25428650 DOI: 10.2217/imt.14.65] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Sarcoidosis is a systemic disease with an incidence of 1 to 40 per 100 000 persons per year. It predominantly affects people in the age of 20 to 40 years old. Disease course varies from mild self-limiting to chronic debilitating and life-threatening disease. Since the cause of sarcoidosis is unknown, curative therapy is not available. Immunosuppressive drugs may, however, control the symptoms of the disease. The hallmark of sarcoidosis is the formation of granulomas that are most commonly found in lungs and lymph nodes. As TNF plays an important role in both formation and maintenance of these granulomas, as well as in the immune response, anti-TNF biologicals such as infliximab and adalimumab are considered a last resort therapeutic option. Clinical effectiveness, however, varies considerably and data showing which patients would benefit most from this expensive therapy are scarce. This review summarizes current knowledge on anti-TNF therapeutics in sarcoidosis, and describes insights on prediction of response, outcome measures and antibody development.
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Affiliation(s)
- Heleen A Crommelin
- Centre of Interstitial Lung Diseases, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
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158
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159
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Saeed S, Kuravi A, Rowley M, Saeed M. A rare cause of severe lactic acidosis. CASE REPORTS 2015; 2015:bcr-2014-206475. [DOI: 10.1136/bcr-2014-206475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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160
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Urinary 8-hydroxy-2'-deoxyguanosine as a novel biomarker of inflammatory activity in patients with cardiac sarcoidosis. Int J Cardiol 2015; 190:319-28. [PMID: 25935620 DOI: 10.1016/j.ijcard.2015.04.144] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 03/17/2015] [Accepted: 04/16/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Inflammation and oxidative stress play a crucial role in the pathogenesis of cardiac sarcoidosis (SAR). We investigated whether urinary (U) 8-hydroxy-2'-deoxyguanosine (8-OHdG)--an oxidative DNA damage marker--was related to SAR inflammatory activity. METHODS U-8-OHdG levels were measured in 31 SAR patients, classified as active (n=17) or non-active (n=14) based on (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG-PET/CT), 28 dilated cardiomyopathy (DCM) patients, and 30 controls. In active SAR patients, U-8-OHdG levels were reexamined and compared with (18)F-FDG-PET/CT results at 6 months after corticosteroid treatment to assess therapeutic response. RESULTS Immunohistochemical examination of left ventricle (LV) autopsy samples from SAR patients revealed positive 8-OHdG staining in cardiomyocyte nuclei from LV sections showing (18)F-FDG accumulation on PET/CT, while serum 8-OHdG levels were significantly higher in the coronary sinus than in the aortic root only in active SAR patients. U-8-OHdG levels in SAR patients were higher than those in controls, and significantly higher in active SAR patients than in non-active SAR and DCM patients. U-8-OHdG was a powerful predictor of active SAR in receiver operating characteristic curve analysis (AUC, 0.98; 95% CI, 0.94-1.02; optimal cutoff value, 13.1 ng/mg creatinine), with a sensitivity of 88.2% and a specificity of 92.9%. U-8-OHdG levels in responders significantly decreased at 6 months after corticosteroid treatment initiation, in proportion with the decrease in the focal cardiac uptake of (18)F-FDG. CONCLUSIONS U-8-OHdG is a potentially clinically useful biomarker for evaluating inflammatory activity and monitoring the effectiveness of corticosteroid therapy in SAR patients.
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161
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In vivo evaluation of TNF-alpha in the lungs of patients affected by sarcoidosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:401341. [PMID: 25866780 PMCID: PMC4383433 DOI: 10.1155/2015/401341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/09/2014] [Accepted: 08/11/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sarcoidosis is a multisystemic granulomatous disorder characterized by multiple noncaseating granulomas involving intrathoracic lymph nodes and lung parenchyma. Recently, the use of anti-tumor necrosis factor alpha (anti-TNFα) agents has been introduced for therapy of chronic and refractory sarcoidosis with controversial results. Infliximab (Remicade) is a chimeric monoclonal antibody (mAb) that recognizes and binds TNFα, neutralizing its biological effects. In the present study, (99m)Tc labelled infliximab was used to study the expression of TNFα in sarcoid lesions and to evaluate its role as a predictive marker in response to therapy with Remicade. MATERIAL AND METHODS A total of 10 patients with newly diagnosed sarcoidosis were enrolled together with 10 control patients affected by rheumatoid arthritis. All patients were studied by planar imaging of the chest with (99m)Tc-infliximab at 6 h and 24 h and total body [(18)F]-FDG PET/CT. Regions of interest were drawn over the lungs and the right arm and target-to-background ratios were analysed for (99m)Tc-infliximab. SUV mean and SUV max were calculated over lungs for FDG. RESULTS AND DISCUSSION Image analysis showed low correlation between T/B ratios and BAL results in patients despite positivity at [(18)F]-FDG PET. CONCLUSION In conclusion, patients with newly diagnosed pulmonary sarcoidosis, with FDG-PET and BAL positivity, showed a negative (99m)Tc-infliximab scintigraphy.
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Marzouk S, Hriz H, Jallouli M, Cherif Y, Bahloul Z. [Association sarcoidosis and Horton disease: report of a case]. Pan Afr Med J 2015. [PMID: 26213599 PMCID: PMC4506795 DOI: 10.11604/pamj.2015.20.98.5946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
La sarcoïdose peut être associée à d'autres maladies inflammatoires. Elle est exceptionnellement associée à une maladie de Horton posant un problème nosologique sur le caractère fortuit ou non de cette association. Nous rapportons l'observation d'une patiente, âgée de 68 ans, chez qui le diagnostic de sarcoïdose avec atteinte rénale, hépatique, oculaire, articulaire et signes généraux a été retenu et ayant été traitée par corticothérapie avec une bonne évolution. 3 ans plus tard elle a présenté des céphalées fronto-temporales associées à une claudication massétérienne et un syndrome inflammatoire biologique. La biopsie de l'artère temporale a conclu à une artérite à cellules géantes. L’évolution a été favorable sous corticothérapie. L'association d'une maladie de Horton à une sarcoïdose suggère un lien éventuel entre ces deux affections.
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Affiliation(s)
- Sameh Marzouk
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Hela Hriz
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Moez Jallouli
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Yosra Cherif
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Zouhir Bahloul
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
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164
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Lee SK, Oh KH, Chung AY, Park HC, Lee SH, Kwon SY, Choi J. Protective role of quercetin against cisplatin-induced hair cell damage in zebrafish embryos. Hum Exp Toxicol 2015; 34:1043-52. [PMID: 25591968 DOI: 10.1177/0960327114567766] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate the protective effects of quercetin on cisplatin-induced hair cell damage in transgenic zebrafish embryos. MATERIALS AND METHODS Five days postfertilization zebrafish embryos were exposed to 1 mM cisplatin and quercetin at 10, 50, 100, or 200 μM for 4 h. Hair cells within neuromasts of the supraorbital, otic, and occipital lateral lines were analyzed by fluorescent microscopy (n = 10). Survival of hair cells was calculated as the average number of hair cells in the control group that were not exposed to cisplatin. Ultrastructural changes were evaluated using scanning electron microscopy. RESULTS Hair cell damage in neuromasts was decreased by co-treatment of quercetin and cisplatin (quercetin 100 μM: 8.6 ± 1.1 cells; 1 mM cisplatin only: 5.0 ± 0.5 cells; n = 10, p < 0.05); apoptosis of hair cells examined by special stain was also decreased by quercetin. The ultrastructure of hair cells within neuromasts was preserved in zebrafish by the combination of quercetin (100 μM) and cisplatin (1 mM). CONCLUSION In conclusion, quercetin showed protective effects against cisplatin-induced toxicity in a zebrafish model. The results of this study suggest the possibility of a protective role of quercetin against cisplatin-induced apoptotic cell death in zebrafish.
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Affiliation(s)
- S K Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - K H Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - A Y Chung
- Laboratory of Neurodevelopmental Genetics, Graduate School of Medicine, Korea University, Ansan, Republic of Korea
| | - H C Park
- Laboratory of Neurodevelopmental Genetics, Graduate School of Medicine, Korea University, Ansan, Republic of Korea
| | - S H Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - S Y Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - J Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
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165
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Isobe M. [The Cutting-edge of Medicine; Clinical features of isolated cardiac sarcoidosis]. ACTA ACUST UNITED AC 2015; 104:120-7. [PMID: 26571786 DOI: 10.2169/naika.104.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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166
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Isobe M, Tezuka D. Isolated cardiac sarcoidosis: clinical characteristics, diagnosis and treatment. Int J Cardiol 2014; 182:132-40. [PMID: 25577749 DOI: 10.1016/j.ijcard.2014.12.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/12/2014] [Accepted: 12/21/2014] [Indexed: 02/07/2023]
Abstract
Sarcoidosis is a systemic disease characterized by the development of noncaseating epithelioid granulomas in multiple organs. Despite extensive investigations over a long period of time, the etiology of this disease remains unknown. Cardiac involvement of this disease is the most ominous complication leading to fatal outcome. Recently, attention has been focused on isolated cardiac sarcoidosis, which exists without clinically apparent sarcoidosis elsewhere. One of the critical issues of isolated cardiac sarcoidosis is difficulty in diagnosis, since existence of the cardiac lesion should be detected from cardiac manifestations alone. Because specificity of biomarkers or sensitivity of histological examination of biopsied sample is very low, diagnosis of isolated cardiac sarcoidosis mainly depends on imaging modalities. In this review article we summarized current knowledge on the pathogenesis of sarcoidosis, clinical features of cardiac sarcoidosis especially that isolated to the heart by showing some typical cases. Utilities and problems of diagnostic imaging tests for this condition including echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography are discussed. Advances in pharmacological and nonpharmacological treatment for cardiac sarcoidosis have improved the prognosis of cardiac sarcoidosis to a great deal; however, there are many issues that remain to be solved in the management of isolated cardiac sarcoidosis.
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Affiliation(s)
- Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan.
| | - Daisuke Tezuka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
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167
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Mouriaux F, Coffin-Pichonnet S, Robert PY, Abad S, Martin-Silva N. [Orbital inflammation]. J Fr Ophtalmol 2014; 37:818-24. [PMID: 25455557 DOI: 10.1016/j.jfo.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
Orbital inflammation is a generic term encompassing inflammatory pathologies affecting all structures within the orbit : anterior (involvement up to the posterior aspect of the globe), diffuse (involvement of intra- and/or extraconal fat), apical (involvement of the posterior orbit), myositis (involvement of only the extraocular muscles), dacryoadenitis (involvement of the lacrimal gland). We distinguish between specific inflammation and non-specific inflammation, commonly referred to as idiopathic inflammation. Specific orbital inflammation corresponds to a secondary localization of a "generalized" disease (systemic or auto-immune). Idiopathic orbital inflammation corresponds to uniquely orbital inflammation without generalized disease, and thus an unknown etiology. At the top of the differential diagnosis for specific or idiopathic orbital inflammation are malignant tumors, represented most commonly in the adult by lympho-proliferative syndromes and metastases. Treatment of specific orbital inflammation begins with treatment of the underlying disease. For idiopathic orbital inflammation, treatment (most often corticosteroids) is indicated above all in cases of visual loss due to optic neuropathy, in the presence of pain or oculomotor palsy.
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Affiliation(s)
- F Mouriaux
- Service d'ophtalmologie, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - S Coffin-Pichonnet
- Service d'ophtalmologie, CHU Caen, avenue de la Côte-de-Nacre, Caen, France
| | - P-Y Robert
- Service d'ophtalmologie, CHU Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - N Martin-Silva
- Service de médecine interne, CHU Caen, avenue de la Côte-de-Nacre, Caen, France
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Agrawal K, Chawla YK, Bhattacharya A, Mittal BR. Fluorodeoxyglucose positron emission tomography/computed tomography findings in nodular hepatic and splenic sarcoidosis. World J Nucl Med 2014; 13:144-5. [PMID: 25191133 PMCID: PMC4150160 DOI: 10.4103/1450-1147.139150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kanhaiyalal Agrawal
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogesh K Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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169
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Orii M, Imanishi T, Akasaka T. Assessment of cardiac sarcoidosis with advanced imaging modalities. BIOMED RESEARCH INTERNATIONAL 2014; 2014:897956. [PMID: 25250336 PMCID: PMC4163361 DOI: 10.1155/2014/897956] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/06/2014] [Accepted: 08/11/2014] [Indexed: 12/29/2022]
Abstract
Sarcoidosis is a chronic systemic disease of unknown etiology that is characterized by the presence of noncaseating epithelioid granulomas, usually in multiple organs. Several studies have shown that sarcoidosis might be the result of an exaggerated granulomatous reaction after exposure to unidentified antigens in genetically susceptible individuals. Cardiac involvement may occur and lead to an adverse outcome: the heart mechanics will be affected and that causes ventricular failure, and the cardiac electrical system will be disrupted and lead to third degree atrioventricular block, malignant ventricular tachycardia, and sudden cardiac death. Thus, early diagnosis and treatment of this potentially devastating disease is critically important. However, sensitive and accurate imaging modalities have not been established. Recent studies have demonstrated the promising potential of cardiac magnetic resonance imaging (MRI) and (18)F-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG PET) in the diagnosis and assessment of cardiac sarcoidosis (CS). In this review, we discuss the epidemiology, etiology, histological findings, and clinical features of sarcoidosis. We also introduce advanced imaging including (18)F-FDG PET and cardiac MRI as more reliable diagnostic modalities for CS.
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Affiliation(s)
- Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
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Andersen R, Nørgaard P, Al-Jailawi MKM, Svane IM. Late development of splenic sarcoidosis-like lesions in a patient with metastatic melanoma and long-lasting clinical response to ipilimumab. Oncoimmunology 2014; 3:e954506. [PMID: 25610749 DOI: 10.4161/21624011.2014.954506] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/18/2014] [Indexed: 01/27/2023] Open
Abstract
A male patient with Stage IV melanoma was treated with ipilimumab resulting in a long-lasting partial response according to RECIST criteria. However, twenty months after ipilimumab treatment, routine follow-up CT scan revealed new splenic lesions initially interpreted as indicative of progressive disease. Nevertheless, a biopsy was performed and histologic evaluation showed that the lesions did not contain malignant cells but rather constituted non-caseating epithelioid cell granulomas consistent with sarcoidosis. As the patient was asymptomatic no treatment was initiated and over the following months the splenic lesions slowly disappeared and to date the patient remains in remission. Ipilimumab is now widely used in the treatment of melanoma patients. Our case-report illustrates that physicians should consider the possibility of ipilimumab induced visceral sarcoidosis-like reactions, mimicking metastatic lesions, developing even many months after ipilimumab treatment. Thus, biopsy of such suspicious lesions is advisable to avoid misinterpretation as disease progression and unnecessary resumption of cancer therapy.
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Affiliation(s)
- Rikke Andersen
- Centre for Cancer Immune Therapy; Department of Haematology and Oncology; Herlev Hospital; University of Copenhagen ; Denmark ; Department of Oncology; Herlev Hospital; University of Copenhagen ; Denmark
| | | | | | - Inge Marie Svane
- Centre for Cancer Immune Therapy; Department of Haematology and Oncology; Herlev Hospital; University of Copenhagen ; Denmark ; Department of Oncology; Herlev Hospital; University of Copenhagen ; Denmark
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Motswaledi MH, Khammissa RAG, Jadwat Y, Lemmer J, Feller L. Oral sarcoidosis: a case report and review of the literature. Aust Dent J 2014; 59:389-94. [DOI: 10.1111/adj.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 12/13/2022]
Affiliation(s)
- MH Motswaledi
- Department of Dermatology; Faculty of Health Sciences; University of Limpopo; Medunsa Campus; South Africa
| | - RAG Khammissa
- Department of Periodontology and Oral Medicine; University of Limpopo; Medunsa Campus; South Africa
| | - Y Jadwat
- Department of Periodontology and Oral Medicine; University of Limpopo; Medunsa Campus; South Africa
| | - J Lemmer
- Department of Periodontology and Oral Medicine; University of Limpopo; Medunsa Campus; South Africa
| | - L Feller
- Department of Periodontology and Oral Medicine; University of Limpopo; Medunsa Campus; South Africa
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Ji XQ, Wang LX, Lu DG. A case of pulmonary sarcoidosis with endobronchial nodules. CLINICAL RESPIRATORY JOURNAL 2014; 10:115-9. [PMID: 24995471 DOI: 10.1111/crj.12174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 05/30/2014] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Xiao-Qing Ji
- Department of Respiratory Medicine; Shandong Provincial Qianfoshan Hospital; Jinan Shandong China
| | - Li-Xia Wang
- Division of Disinfecting and Supply; Liaocheng People's Hospital; Liaocheng Shandong China
| | - De-Gan Lu
- Department of Respiratory Medicine; Shandong Provincial Qianfoshan Hospital; Jinan Shandong China
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Feng X, Zang S, Yang Y, Zhao S, Li Y, Gao X, Zhang L. Annexin A11 (ANXA11) gene polymorphisms are associated with sarcoidosis in a Han Chinese population: a case-control study. BMJ Open 2014; 4:e004466. [PMID: 25056970 PMCID: PMC4120255 DOI: 10.1136/bmjopen-2013-004466] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To further identify the single-nucleotide polymorphisms (SNPs) that contribute to the genetic susceptibility to sarcoidosis, we examined the potential association between sarcoidosis and 15 SNPs of the ANXA11 gene. DESIGN A case-control study. SETTING A tuberculosis unit in a hospital of the university in China. PARTICIPANTS Participants included 412 patients with sarcoidosis and 418 healthy controls. METHODS The selected SNPs were genotyped using the MALDI-TOF in the MassARRAY system. RESULTS Statistically significant differences were found in the allelic or genotypic frequencies of the rs2789679, rs1049550 and rs2819941 in the ANXA11 gene between patients with sarcoidosis and controls. The rs2789679 A allele (p=0.00004, OR=1.42, 95% CI 1.17 to 1.73) and rs2819941 T allele (p=0.0006, OR=1.41, 95% CI 1.16 to 1.71) were significantly more frequent in patients with sarcoidosis compared with controls. The frequency of the rs1049550 T allele (p=0.000002, OR=0.61, 95% CI 0.49 to 0.74) in patients with sarcoidosis was significantly lower than that in controls. The multi-SNP model reveals that rs1049550 is the only independent SNP association effect after accounting for the other two marginally associated SNPs. In block 2 (rs1049550-rs2573351), the T-C haplotype occurred significantly less frequently (p=0.001), whereas the C-C haplotypes occurred more frequently (p=0.0001) in patients with sarcoidosis than controls. Furthermore, genotype frequency distribution revealed that, in rs1049550, the CC genotype was significantly more in patients with chest X-ray (CXR) stage I sarcoidosis than in patients with CXR stage II-IV sarcoidosis (p=0.012). CONCLUSIONS These findings point to a role for the polymorphisms of ANXA11 in sarcoidosis in a Chinese Han population, and may be informative for future genetic studies on sarcoidosis.
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Affiliation(s)
- Xianjun Feng
- Department of respiratory medicine, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, PR China
| | - Shuzhi Zang
- Department of respiratory medicine, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, PR China
| | - Yanrong Yang
- Department of respiratory medicine, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, PR China
| | - Shasha Zhao
- Department of respiratory medicine, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, PR China
| | - Yunxia Li
- Department of respiratory medicine, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, PR China
| | - Xinyuan Gao
- Department of respiratory medicine, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, PR China
| | - Ligong Zhang
- Department of respiratory medicine, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, PR China
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Naruse Y, Sekiguchi Y, Nogami A, Okada H, Yamauchi Y, Machino T, Kuroki K, Ito Y, Yamasaki H, Igarashi M, Tada H, Nitta J, Xu D, Sato A, Aonuma K. Systematic treatment approach to ventricular tachycardia in cardiac sarcoidosis. Circ Arrhythm Electrophysiol 2014; 7:407-13. [PMID: 24837644 DOI: 10.1161/circep.113.000734] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatal arrhythmia is commonly observed in cardiac sarcoidosis, but clinical effects of a systematic treatment approach are still uncertain. This study sought to describe both clinical and electrophysiological characteristics and outcomes of systematic treatment approach to ventricular tachycardia (VT) associated with cardiac sarcoidosis. METHODS AND RESULTS We enrolled 37 consecutive patients (11 men; age, 56±11 years) with a diagnosis of sustained VT associated with cardiac sarcoidosis. Clinical effects of a systematic treatment approach including medical therapy (both steroid and antiarrhythmic agents), in association with radiofrequency catheter ablation, were evaluated. All patients received antiarrhythmic agents, and 34 received steroid therapy. During a 39-month follow-up, 23 (62%) patients were free from any VT episodes with medical therapy. Multivariable Cox regression analyses revealed that the absence of gallium-67 myocardial uptake was an independent predictor for VT recurrence (hazard ratio, 7.51; 95% confidence interval, 1.65-34.26; P<0.01). Fourteen patients who experienced VT recurrences even while on drug therapy underwent radiofrequency catheter ablation. Electrophysiological study revealed that the mechanisms of VTs could be classified into 2 subgroups: Purkinje-related or scar-related VT. The QRS duration of VT was narrower in Purkinje-related than in scar-related VTs (157±23 versus 183±22 ms; P<0.05). After a 33-month follow-up subsequent to the radiofrequency catheter ablation, 6 of 14 patients experienced VT recurrence. The number of VTs sustained during electrophysiological study was higher in the patients with VT recurrence than in those without (3.7±1.4 versus 1.9±0.8; P<0.01). CONCLUSIONS A systematic treatment approach to cardiac sarcoidosis with VT successfully suppressed VT recurrences in the majority of patients studied.
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Affiliation(s)
- Yoshihisa Naruse
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Yukio Sekiguchi
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.).
| | - Akihiko Nogami
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Hiroyuki Okada
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Yasuteru Yamauchi
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Takeshi Machino
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Kenji Kuroki
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Yoko Ito
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Hiro Yamasaki
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Miyako Igarashi
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Hiroshi Tada
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Junichi Nitta
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Dongzhu Xu
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Akira Sato
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
| | - Kazutaka Aonuma
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.N., Y.S., A.N., T.M., K.K., Y.I., H.Y., M.I., H.T., D.X., A.S., K.A.); Cardiovascular Division, Musashino Red Cross Hospital, Musashino, Tokyo, Japan (H.O., Y.Y.); and Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Saitama, Japan (J.N.)
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Murphy KP, Kennedy MP, Barry JE, O'Regan KN, Power DG. New-Onset Mediastinal and Central Nervous System Sarcoidosis in a Patient with Metastatic Melanoma Undergoing CTLA4 Monoclonal Antibody Treatment. Oncol Res Treat 2014; 37:351-3. [DOI: 10.1159/000362614] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/11/2013] [Indexed: 11/19/2022]
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Mahapatra QS, Sahai K, Rathi KR, Singh S, Sharma S. Pulmonary sarcoidosis: An important differential diagnosis in transbronchial lung biopsies. Lung India 2014; 31:139-41. [PMID: 24778476 PMCID: PMC3999673 DOI: 10.4103/0970-2113.129839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disease of unknown etiology. Lungs and lymphatics are the principal sites affected by this disease. The disorder is often not suspected by physicians. MATERIALS AND METHODS This was a retrospective study done on 140 transbronchial lung biopsies received for histopathological examination in the Department of Pathology for 1 year in a multispeciality tertiary care hospital, in Delhi. RESULTS Out of 140 transbronchial lung biopsies studied, 13 cases of sarcoidosis were diagnosed histopathologically. In these patients a clinical, pathological, and radiological corelation was done. And a final diagnosis of sarcoidosis was given after excluding other granulomatous lesions. CONCLUSION Transbronchial lung biopsies have become an important tool in the diagnosis of sarcoidosis in present time. Hence sarcoidosis should be considered as a differential diagnosis when dealing with granulomatous lesions in lung biopsies.
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Affiliation(s)
- Qury S Mahapatra
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
| | - Kavita Sahai
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
| | - K R Rathi
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
| | - Sarvinder Singh
- Department of Respiratory Med, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
| | - Shruti Sharma
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
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Abstract
Sarcoidosis is a systemic disease of unknown cause that is characterised by the formation of immune granulomas in various organs, mainly the lungs and the lymphatic system. Studies show that sarcoidosis might be the result of an exaggerated granulomatous reaction after exposure to unidentified antigens in individuals who are genetically susceptible. Several new insights have been made, particularly with regards to the diagnosis and care of some important manifestations of sarcoidosis. The indications for endobronchial ultrasound in diagnosis and for PET in the assessment of inflammatory activity are now better specified. Recognition of unexplained persistent disabling symptoms, fatigue, small-fibre neurological impairment, cognitive failure, and changes to health state and quality of life, has improved. Mortality in patients with sarcoidosis is higher than that of the general population, mainly due to pulmonary fibrosis. Predicted advances for the future are finding the cause of sarcoidosis, and the elucidation of relevant biomarkers, reliable endpoints, and new efficient treatments, particularly in patients with refractory sarcoidosis, lung fibrosis, and those with persistent disabling symptoms.
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Affiliation(s)
- Dominique Valeyre
- Department of Pneumology, Assistance Publique Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France; University Paris 13, Sorbonne Paris Cité, Bobigny, France.
| | - Antje Prasse
- Department of Pneumology, University Hospital, Freiburg, Germany
| | - Hilario Nunes
- Department of Pneumology, Assistance Publique Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France; University Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Yurdagul Uzunhan
- Department of Pneumology, Assistance Publique Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France; University Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Pierre-Yves Brillet
- Department of Radiology, Assistance Publique Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France; University Paris 13, Sorbonne Paris Cité, Bobigny, France
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Abstract
Nasal crusting, rhinitis, and sinusitis are presentations of common conditions; however, these can also be the presenting symptoms of an underlying systemic disorder such as an infection, malignancy, or granulomatous disease. Granulomatous diseases with head and neck manifestations include Wegener's granulomatosis, Churg-Strauss syndrome, and sarcoidosis. These diseases are managed through a multidisciplinary approach that often includes otolaryngologists. This article presents a brief review of granulomatous diseases and their rhinologic manifestations and includes relevant diagnostic tests and systemic and local treatment options.
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Affiliation(s)
- Michael A Kohanski
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Sinus Center, Baltimore, Maryland 21287, USA
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Le Bras E, Ehrenstein B, Fleck M, Hartung W. Evaluation of Ankle Swelling Due to Lofgren's Syndrome: A Pilot Study Using B-Mode and Power Doppler Ultrasonography. Arthritis Care Res (Hoboken) 2014; 66:318-22. [DOI: 10.1002/acr.22099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/30/2013] [Indexed: 11/12/2022]
Affiliation(s)
- E. Le Bras
- Asklepios Clinic, Bad Abbach, and University of Regensburg; Regensburg Germany
| | | | - M. Fleck
- Asklepios Clinic, Bad Abbach, and University of Regensburg; Regensburg Germany
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Abstract
Sarcoidosis is a multiorgan system disease that often presents insidiously. The diagnosis is often made fortuitously upon routine chest radiography or that done for other reasons. Blacks are more commonly affected than whites and age of onset is typically adolescents to young adults. Lung involvement is common and symptoms may include cough, dyspnea and chest pain. Extrapulmonary symptoms may include the skin, joint and eye findings. Bilateral hilar adenopathy is the classic finding on chest radiograph. Anemia or other cell line deficiencies, elevated liver enzymes, hypercalciuria, and EKG abnormalities may also be present. Angiotensin converting enzyme levels may be elevated but are not diagnostic. Histopathological confirmation of noncaseating granulomas is essential for diagnosis. It is generally performed through a biopsy of the most peripheral site possible, although transbronchial biopsy is commonly required. Finally, other possible etiologies must be evaluated and differentiated with a particular emphasis on tuberculosis due to the multiple overlapping symptoms and findings. Newer techniques such as proteomics and transcriptional gene signatures may contribute to the understanding of the pathophysiology of sarcoidosis, and may even serve as diagnostic tools in the future.
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Affiliation(s)
- Robert Heinle
- Division of Pulmonology, Department of Pediatrics, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE 19803, United States
| | - Christopher Chang
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE 19803, United States.
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Segura AM, Radovancevic R, Demirozu ZT, Frazier O, Buja LM. Granulomatous myocarditis in severe heart failure patients undergoing implantation of a left ventricular assist device. Cardiovasc Pathol 2014; 23:17-20. [DOI: 10.1016/j.carpath.2013.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 05/13/2013] [Accepted: 06/27/2013] [Indexed: 01/08/2023] Open
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Nagata K, Maruyama K, Sugita S, Fukuchi U, Terada Y, Ishizuka A, Nakazawa T, Mochizuki M, Kinoshita S. Age Differences in Sarcoidosis Patients with Posterior Ocular Lesions. Ocul Immunol Inflamm 2013; 22:257-62. [DOI: 10.3109/09273948.2013.855796] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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184
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Yokoseki A, Saji E, Arakawa M, Kosaka T, Hokari M, Toyoshima Y, Okamoto K, Takeda S, Sanpei K, Kikuchi H, Hirohata S, Akazawa K, Kakita A, Takahashi H, Nishizawa M, Kawachi I. Hypertrophic pachymeningitis: significance of myeloperoxidase anti-neutrophil cytoplasmic antibody. ACTA ACUST UNITED AC 2013; 137:520-36. [PMID: 24271323 DOI: 10.1093/brain/awt314] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this study was to elucidate the characteristics, pathogenesis and treatment strategy of hypertrophic pachymeningitis that is associated with myeloperoxidase anti-neutrophil cytoplasmic antibody (ANCA). We retrospectively investigated clinical, radiological, immunological and pathological profiles of 36 patients with immune-mediated or idiopathic hypertrophic pachymeningitis, including 17 patients with myeloperoxidase-ANCA, four patients with proteinase 3-ANCA, six patients with other immune-mediated disorders, and nine patients with 'idiopathic' variety. Myeloperoxidase-ANCA-positive hypertrophic pachymeningitis was characterized by: (i) an elderly female predominance; (ii) 82% of patients diagnosed with granulomatosis with polyangiitis (previously known as Wegener's granulomatosis) according to Watts' algorithm; (iii) a high frequency of patients with lesions limited to the dura mater and upper airways, developing headaches, chronic sinusitis, otitis media or mastoiditis; (iv) a low frequency of patients with the 'classical or generalized form' of granulomatosis with polyangiitis involving the entire upper and lower airways and kidney, or progressing to generalized disease, in contrast to proteinase 3-ANCA-positive hypertrophic pachymeningitis; (v) less severe neurological damage according to the modified Rankin Scale and low disease activity according to the Birmingham Vasculitis Activity Score compared with proteinase 3-ANCA-positive hypertrophic pachymeningitis; (vi) increased levels of CXCL10, CXCL8 and interleukin 6 in cerebrospinal fluids, and increased numbers of T cells, neutrophils, eosinophils, plasma cells and monocytes/macrophages in autopsied or biopsied dura mater with pachymeningitis, suggesting TH1-predominant granulomatous lesions in hypertrophic pachymeningitis, as previously reported in pulmonary or renal lesions of granulomatosis with polyangiitis; and (vii) greater efficacy of combination therapy with prednisolone and cyclophosphamide compared with monotherapy with prednisolone. Proteinase 3-ANCA may be considered a marker for more severe neurological damage, higher disease activity and a higher frequency of the generalized form compared with myeloperoxidase-ANCA-positive hypertrophic pachymeningitis. However, categorization into 'granulomatosis with polyangiitis' according to Watts' algorithm and immunological or pathological features were common in both proteinase 3- and myeloperoxidase-ANCA-positive hypertrophic pachymeningitis. These data indicate that most patients with myeloperoxidase-ANCA-positive hypertrophic pachymeningitis should be categorized as having the central nervous system-limited form of ANCA-associated vasculitis, consistent with the concept of ophthalmic-, pulmonary- or renal-limited vasculitis.
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Affiliation(s)
- Akiko Yokoseki
- 1 Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
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Konidaris VE, Empeslidis T. Ranibizumab in choroidal neovascularisation associated with ocular sarcoidosis. BMJ Case Rep 2013; 2013:bcr-2013-010288. [PMID: 24234427 DOI: 10.1136/bcr-2013-010288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 81-year-old Caucasian man with a history of chronic bilateral panuveitis associated with sarcoidosis presented with visual acuity 1.0 LogMAR in the right and 0.5 LogMAR in the left eye. Following fluoroscein angiogram bilateral choroidal neovascular membrane was established. Treatment was initiated with a course of 3 monthly intravitreal injections of ranibizumab 0.5 mg in 0.05 mL bilaterally; oral prednisolone 30 mg/day on tapering doses controlled the ocular inflammation prior to the treatment with intravitreal injections. An additional two intravitreal ranibizumab injections were administered in the right eye. Fibrotic tissue in the posterior pole bilaterally was present on funduscopy following ranibizumab treatment. Visual acuity was LogMAR 1.6 in the right and 1.0 LogMAR in the left eye in 1 year follow-up. This case report summarises the issues of choroidal neovascularisation as a complication secondary to panuveitis associated with sarcoidosis and highlights the treatment of this complication with antivascular endothelial growth factor agents.
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186
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Association of six well-characterized polymorphisms in TNF-α and TNF-β genes with sarcoidosis: a meta-analysis. PLoS One 2013; 8:e80150. [PMID: 24244632 PMCID: PMC3820546 DOI: 10.1371/journal.pone.0080150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/30/2013] [Indexed: 12/03/2022] Open
Abstract
Backgrounds In this study, we aimed to investigate the association of six well-characterized polymorphisms in tumor necrosis factor alpha and beta (TNF-α and TNF-β) genes with the risk for sarcoidosis via a comprehensive meta-analysis. Methods And Findings The electronic MEDLINE (Ovid) and PubMed databases covering the period from the earliest possible year to June 2013 were searched. Total 13 qualified articles including 1584 patients with sarcoidosis and 2636 controls were recruited. The data were analyzed by RevMan software, and risk estimates were expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs). Analyses of the full data set failed to identify any significant association of TNF-α gene -307A (OR=1.25; 95% CI: 0.98-1.59), -1031C (OR=0.88; 95% CI: 0.71-1.1), -863A (OR=0.89; 95% CI: 0.72-1.11), -238A (OR=0.97; 95% CI: 0.71-1.32), and -857T (OR=1.14; 95% CI: 0.74-1.77) alleles, but a significant association for TNF-β 252A allele (OR=1.65; 95%CI = 1.33-2.04; P<0.00001). Under a random-effects allelic model, there was marginally significant increased risk of sarcoidosis for -307A allele among Caucasians (OR=1.25; 95% CI: 0.96-1.62; P=0.09) but not among Asians (OR=2.12; 95% CI: 0.31-14.27; P=0.44). There was a low probability of publication bias as reflected by the fail-safe number. Conclusions This meta-analysis extended previous findings on the association between the TNF-α and TNF-β genetic polymorphisms and sarcoidosis, by showing that the TNF-β gene A252G polymorphism might be a potential risk factor for the development of sarcoidosis.
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187
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Song GG, Kim JH, Lee YH. Associations between TNF-α −308 A/G and lymphotoxin-α +252 A/G polymorphisms and susceptibility to sarcoidosis: a meta-analysis. Mol Biol Rep 2013; 41:259-67. [DOI: 10.1007/s11033-013-2859-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
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Renal sarcoidosis with limited lung manifestations expressing Propionibacterium acnes antigens in the affected tubulointerstitium. Am J Med Sci 2013; 346:250-2. [PMID: 23531993 DOI: 10.1097/maj.0b013e31828bdf9f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sarcoidosis is a granulomatous multisystemic disorder of unknown origin that can affect the kidneys. Previous reports from Japan and Europe have indicated a link between Propionibacterium acnes infections and sarcoidosis. Here, we present the case of a 68-year-old woman with hypercalcemia and renal failure. A kidney biopsy was performed, which showed granulomatous tubulointerstitial nephritis with a large nonnecrotic nodule that contained mononuclear inflammatory cells and multinucleated giant cells. Subsequent immunohistochemical analysis revealed intracytoplasmic structures, which strongly indicated the presence of the P acnes antigen. Treatment with methylprednisolone ameliorated the patient's hypercalcemia and renal failure. This case report emphasizes the potential of chronic P acnes infection to cause sarcoidosis.
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189
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Kwon YS, Jung HI, Kim HJ, Lee JW, Choi WI, Kim JY, Rho BH, Lee HW, Kwon KY. Isolated cervical lymph node sarcoidosis presenting in an asymptomatic neck mass: a case report. Tuberc Respir Dis (Seoul) 2013; 75:116-9. [PMID: 24101936 PMCID: PMC3790023 DOI: 10.4046/trd.2013.75.3.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/14/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-α in the granuloma. However, transforming growth factor-β was not expressed, although interleukin-1β was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma.
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Affiliation(s)
- Yong Shik Kwon
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Kamata M, Tada Y, Mitsui A, Shibata S, Miyagaki T, Asano Y, Sugaya M, Kadono T, Sato S. ICAM-1 deficiency exacerbates sarcoid-like granulomatosis induced by Propionibacterium acnes through impaired IL-10 production by regulatory T cells. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 183:1731-1739. [PMID: 24103557 DOI: 10.1016/j.ajpath.2013.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 08/12/2013] [Accepted: 08/15/2013] [Indexed: 01/12/2023]
Abstract
Propionibacterium acnes has been implicated as one of the suggested causative antigens for sarcoidosis, a systemic granulomatous disease. By injecting heat-killed P. acnes into the dorsal skin of C57BL/6J mice on days 1, 3, 5, and 14, sarcoid-like granulomatosis was induced in skin and lungs of these mice on day 28. To clarify the role of cell adhesion molecules in cutaneous sarcoidosis, we induced sarcoid-like granulomatosis in mice deficient of intercellular adhesion molecule (ICAM)-1, L-selectin, P-selectin, or E-selectin via repeated P. acnes injection. Histopathologic analysis revealed that granuloma formation was aggravated in the skin and lungs of ICAM-1-deficient mice compared with wild-type mice. Within skin granulomas of ICAM-1-deficient mice, P. acnes immunization up-regulated mRNA expression of tumor necrosis factor-α, although it failed to induce IL-10 mRNA expression in contrast to wild-type mice. Infiltration of regulatory T cells into skin granuloma was similar between wild-type mice and ICAM-1-deficient mice. P. acnes immunization induced IL-10 production by CD4(+)CD25(+)Foxp3(+) regulatory T cells in lymph nodes of wild-type mice in vivo, which was absent in regulatory T cells of ICAM-1-deficient mice. Our results indicate that ICAM-1 is imperative for inducing regulatory T cells to produce IL-10 in vivo, which would prevent granuloma formation.
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Affiliation(s)
- Masahiro Kamata
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yayoi Tada
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
| | - Aya Mitsui
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Sayaka Shibata
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Makoto Sugaya
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takafumi Kadono
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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191
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Arana Yi C, McCue P, Rosen M, Machtay M, Axelrod R, Morris GJ. Sarcoidosis Mimicking Metastatic Bone Disease in Head and Neck Cancer. Semin Oncol 2013; 40:529-34. [DOI: 10.1053/j.seminoncol.2013.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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192
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Braam AWE, de Haan SN, Vorselaars ADM, Rijkers GT, Grutters JC, van den Elshout FJJ, Korenromp IHE. Influence of repeated maximal exercise testing on biomarkers and fatigue in sarcoidosis. Brain Behav Immun 2013; 33:57-64. [PMID: 23727274 DOI: 10.1016/j.bbi.2013.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/14/2013] [Accepted: 05/21/2013] [Indexed: 01/08/2023] Open
Abstract
Fatigue in the immune mediated inflammatory disease sarcoidosis is thought to be associated with impaired exercise tolerance. This prospective study assessed fatigue and recuperative capacity after repeated exercise, and examined whether changing concentrations in biomarkers upon exercise are associated with fatigue. Twenty sarcoidosis patients and 10 healthy volunteers performed maximal cardiopulmonary exercise tests on two successive days. Concentrations of cytokines, stress hormones, ACE and CK were assessed before and after the two exercise tests, and 3 days thereafter. All participants completed a sleep diary. Severely fatigued patients showed significant lower VO2 max (p=0.038, p=0.022) and maximal workload (p=0.034, p=0.028) on both exercise tests compared to healthy controls. No impairment of maximal exercise testing was demonstrated during the second cycling test in any group. Fatigue was not correlated with changes in concentrations of biomarkers upon exercise. Severely fatigued patients rated both tests as significantly more fatiguing, and reported significant lower mean subjective night sleeping time during the testing period. Fatigue in sarcoidosis patients cannot be objectified by reduction of exercise capacity after repeated maximal exercise testing, and is not correlated with significant changes in biomarkers. Severe fatigue is only and consistently featured by patient reported outcomes.
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Affiliation(s)
- A W E Braam
- Rijnstate Hospital, Arnhem, The Netherlands; Beatrix Hospital, Gorinchem, The Netherlands
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193
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Han EJ, Jang YS, Lee IS, Lee JM, Kang S, Kim HS. Muscular sarcoidosis detected by F-18 FDG PET/CT in a hypercalcemic patient. J Korean Med Sci 2013; 28:1399-402. [PMID: 24015050 PMCID: PMC3763119 DOI: 10.3346/jkms.2013.28.9.1399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 04/23/2013] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology that involves many organs, occasionally mimicking malignancy. We herein report a 50-yr-old woman of muscular sarcoidosis of chronic myopathic type, manifested by hypercalcemia and muscle wasting. Besides insignificant hilar lymphadenopathy, her sarcoidosis was confined to generalized atrophic muscles and therefore, F-18 FDG PET/CT alone among conventional imaging studies provided diagnostic clues for the non-parathyroid-related hypercalcemia. On follow-up PET/CT during low-dose steroid treatment, FDG uptake in the muscles disappeared whereas that in the hilar lymph nodes remained. PET/CT may be useful in the evaluation of unexpected disease extent and monitoring treatment response in suspected or known sarcoidosis patients.
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Affiliation(s)
- Eun Ji Han
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yi Sun Jang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Suk Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Min Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Siwon Kang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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194
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Sarcoidosis mimicking metastatic gynaecological malignancies: A diagnostic and therapeutic challenge? Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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195
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Laryngeal Sarcoidosis: A Case Report Presenting Transglottic Involvement. J Voice 2013; 27:647-9. [DOI: 10.1016/j.jvoice.2013.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 03/22/2013] [Indexed: 11/20/2022]
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196
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Meta-analysis of genetic programs between idiopathic pulmonary fibrosis and sarcoidosis. PLoS One 2013; 8:e71059. [PMID: 23967151 PMCID: PMC3743918 DOI: 10.1371/journal.pone.0071059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/24/2013] [Indexed: 11/19/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) and pulmonary sarcoidosis are typical interstitial lung diseases with unknown etiology that cause lethal lung damages. There are notable differences between these two pulmonary disorders, although they do share some similarities. Gene expression profiles have been reported independently, but differences on the transcriptional level between these two entities have not been investigated. Methods/Results All expression data of lung tissue samples for IPF and sarcoidosis were from published datasets in the Gene Expression Omnibus (GEO) repository. After cross platform normalization, the merged sample data were grouped together and were subjected to statistical analysis for finding discriminate genes. Gene enrichments with their corresponding functions were analyzed by the online analysis engine “Database for Annotation, Visualization and Integrated Discovery” (DAVID) 6.7, and genes interactions and functional networks were further analyzed by STRING 9.0 and Cytoscape 3.0.0 Beta1. One hundred and thirty signature genes could potentially differentiate one disease state from another. Compared with normal lung tissue, tissue affected by IPF and sarcoidosis displayed similar signatures that concentrated on proliferation and differentiation. Distinctly expressed genes that could distinguish IPF from sarcoidosis are more enriched in processes of cilium biogenesis or degradation and regulating T cell activations. Key discriminative network modules involve aspects of bone morphogenetic protein receptor two (BMPR2) related and v-myb myeloblastosis viral oncogene (MYB) related proliferation. Conclusions This study is the first attempt to examine the transcriptional regulation of IPF and sarcoidosis across different studies based on different working platforms. Groups of significant genes were found to clearly distinguish one condition from the other. While IPF and sarcoidosis share notable similarities in cell proliferation, differentiation and migration, remarkable differences between the diseases were found at the transcription level, suggesting that the two diseases are regulated by overlapping yet distinctive transcriptional networks.
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Abstract
PURPOSE The aim of this study was to compare uptake lesions in sarcoidosis and IgG4-related disease through gallium-67 ((67)Ga) scintigraphy to differentiate between the two diseases. MATERIALS AND METHODS Whole-body (67)Ga scintigraphy findings of 27 patients with sarcoidosis and 16 with IgG4-related disease were reviewed between 2005 and 2011 at our hospital. RESULTS In the case of patients with sarcoidosis, significant accumulation of (67)Ga was observed in the lacrimal gland in the case of 26 patients (96%), in mediastinal lymph nodes (LNs) in 23 (85%), in pulmonary hilar LNs in 21 (78%), in the parotid gland in 10 (38%), in supraclavicular LNs in eight (30%), in muscles in seven (26%), in the lung in five (18%), in inguinal LNs in four (15%), in submandibular LNs in two (7%), and in the heart, spleen, kidney and para-aorta in one patient (4%). In patients with IgG4-related disease, abnormal uptake was detected in the pulmonary hilar LNs in 12 patients (75%), in the lacrimal gland in 10 (62%), in the pancreas in 10 (62%), in the parotid gland in six (37%), in the submandibular gland in six (37%), in the para-aorta in three (19%), in the lung in three (19%), in mediastinal LNs in two (12%), and in the kidney in the case of two patients (12%). Asymmetrical accumulation in the submandibular gland was observed in three of six patients (50%) with IgG4-related disease and in none of the two patients (0%) with sarcoidosis. Significant differences were observed in the uptake ratio of the lacrimal gland, the submandibular gland, supraclavicular LNs, mediastinal LNs, pancreas, and muscle between the two groups (P<0.05). CONCLUSION (67)Ga scintigraphy was useful in differentiating between the two diseases. Uptake in mediastinal LNs, in supraclavicular LNs, and in the muscle was specific to sarcoidosis, whereas uptake in the pancreas and in the submandibular gland indicated IgG4-related disease.
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198
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Martikainen MH, Grönroos JO, Vuorinen T. Detection of human herpesvirus 7 DNA from the CSF in association with neurosarcoidosis. J Med Virol 2013; 85:1935-9. [PMID: 23852835 DOI: 10.1002/jmv.23683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 01/24/2023]
Abstract
This study reports a previously healthy, immunocompetent adult male in whom human herpesvirus 7 (HHV-7) DNA was detected continuously from the cerebrospinal fluid (CSF). This patient developed definite sarcoidosis with primary symptomatic manifestations in the central nervous system (CNS). The initial presentation was with loss of visual acuity and papilledema. Brain MR imaging at presentation confirmed papilledema, but otherwise there were no focal abnormalities or signs of hydrocephalus. CSF investigation revealed pleocytosis and elevated protein levels. HHV-7 DNA was detected repeatedly from CSF but not from blood over 1 year follow-up. High resolution computed tomography of lungs was normal. Positron emission tomography showed several metabolically active lymph nodes in the mediastinum, and the histopathological investigation revealed granulomatous inflammation consistent with sarcoidosis. The finding of HHV-7 DNA in the CSF in the context of neurosarcoidosis has not been reported previously. The detection of HHV-7 DNA may result from the selective activation of CD4+ T-lymphocytes in the CSF caused by neurosarcoidosis. Further studies are needed to establish whether the detection of HHV-7 DNA in the CSF in association with neurosarcoidosis represents a clinically significant HHV-7 CNS infection.
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Affiliation(s)
- Mika H Martikainen
- Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland.
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Joshita S, Shirahata K, Yazaki Y, Okaniwa S, Nakamura Y, Kimura T, Noami S, Horigome R, Yagi H, Ito N, Yamazaki A, Akahane Y, Umemura T, Yoshizawa K, Tanaka E, Ota M. Cutaneous sarcoidosis in a chronic hepatitis C patient receiving pegylated interferon and ribavirin therapy. Hepatol Res 2013; 43:801-7. [PMID: 23675767 DOI: 10.1111/hepr.12021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/21/2012] [Accepted: 11/05/2012] [Indexed: 02/08/2023]
Abstract
A 61-year-old Japanese woman suffered from a small, painful, subcutaneous nodule on the sole of her foot that was 10 mm across in diameter during pegylated interferon (PEG IFN) and ribavirin (RBV) combination therapy for chronic hepatitis C. Skin biopsy revealed multiple non-caseating granulomas composed of epithelioid histiocytes with multinucleate giant cells, which was consistent with sarcoidosis. Ophthalmologic examination revealed uveitis. Thoracic computed tomography (CT) showed multiple bilateral hilar lymphadenopathies and a diffuse micronodular interstitial pattern of the lungs. Genetic analysis indicated a probable homozygous haplotype of A*02:01-C*15:02-B*51:01-DRB1*16:02-DQB1*05:02 in human leukocyte antigen regions. The patient was observed carefully without any additional medication because no significant systemic symptoms were noted. Combination therapy was continued for 2 months afterwards. She was asymptomatic for over 3 years of follow up, and repeated hematological and biological investigations and chest CT showed improvement. In conclusion, clinicians should bear sarcoidosis in mind as a complication during PEG IFN and RBV combination therapy. They should also be aware of the usually good prognosis of PEG IFN-induced cutaneous sarcoidosis in order not to prematurely discontinue a treatment necessary for liver disease; maintenance of PEG IFN treatment may be advised with careful follow up.
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Affiliation(s)
- Satoru Joshita
- Department of Gastroenterology, Iida Municipal Hospital, Iida; Department of Medicine, Division of Gastroenterology and Hepatology, Matsumoto Hospital, Matsumoto
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