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Sahinoğlu I, Uslu S. Heerfordt's syndrome: a rare manifestation of neurosarcoidosis. Acta Neurol Belg 2024; 124:1419-1421. [PMID: 38261165 DOI: 10.1007/s13760-024-02481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Irem Sahinoğlu
- Division of Rheumatology, Celal Bayar University School of Medicine, Uncubozköy, 45030, Manisa, Turkey
| | - Sadettin Uslu
- Division of Rheumatology, Celal Bayar University School of Medicine, Uncubozköy, 45030, Manisa, Turkey.
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Błasińska K, Jędrych ME, Opoka L, Tomkowski W, Szturmowicz M. Imaging Plays a Key Role in the Diagnosis and Control of the Treatment of Bone Sarcoidosis. Biomedicines 2023; 11:1866. [PMID: 37509505 PMCID: PMC10377349 DOI: 10.3390/biomedicines11071866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown origin. The most frequent localizations are thoracic lymph nodes and/or parenchymal lung disease, nevertheless any other organ may be involved. Musculoskeletal sarcoidosis, previously considered a rare manifestation of the disease, is presently recognized with increasing frequency, due to the development of modern imaging modalities. The classical X-ray sign of bone sarcoidosis is the image of lace in the phalanges of the hands. Most other locations present with atypical radiological images. Therefore, they may mimic metastatic neoplastic disease, especially when they are the first sign of sarcoidosis not previously recognized. On such occasions, none of the imaging methods will give the correct diagnosis, histopathological verification, monitoring of lesions or clinical data in a patient with confirmed sarcoidosis are indicated. The article summarizes the current status of knowledge concerning the recognition and therapy of bone sarcoidosis. In addition, an illustrative case of patient with bone and bone marrow sarcoidosis is presented.
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Affiliation(s)
- Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Małgorzata Ewa Jędrych
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Lucyna Opoka
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Monika Szturmowicz
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
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3
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The Risk of Sarcoidosis Misdiagnosis and the Harmful Effect of Corticosteroids When the Disease Picture Is Incomplete. Biomedicines 2023; 11:biomedicines11010175. [PMID: 36672683 PMCID: PMC9855435 DOI: 10.3390/biomedicines11010175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Sarcoidosis is a complex granulomatous disease of unknown etiology. Due to the heterogeneity of the disease, the diagnosis remains challenging in many cases, often at the physician's discretion, requiring a thorough and complex investigation. Many other granulomatous diseases have the potential to mimic sarcoidosis, whether infectious, occupational, or autoimmune diseases and starting an unnecessary corticosteroid treatment can worsen the patient's prognosis, leading to side effects that can be harder to treat than the actual disease.
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4
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Grover A, Puri S, Chabra S, Mehta M, Mishra PC. Isolated bone marrow sarcoidosis presenting as fever of unknown origin in a case of chronic myeloid leukemia. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Isolated involvement of bone marrow in sarcoidosis has not been reported commonly. Sarcoidosis is a systemic granulomatous disease of unknown origin, characterized by the presence of non-caseating granulomatous lesions. There should be high index of suspicion in patients having underlying lymphoproliferative malignancies.
Case presentation
We present a 27-year-old male, known case of chronic myeloid leukemia, presenting as fever of unknown origin diagnosed with isolated bone marrow sarcoidosis.
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Braun T, Schulz E, Viard M, AlhajOmar O, Struffert T, Gattenloehner S, Yeniguen M, Juenemann M. Case Report: A Well-Hidden Cause for Myelopathy. Front Neurol 2021; 12:672648. [PMID: 33959094 PMCID: PMC8093783 DOI: 10.3389/fneur.2021.672648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Sarcoidosis is a rare, systemic inflammatory disease and can involve multiple organs, especially the lungs and lymph nodes. The nervous system is affected in <10 percent of patients, which is called neurosarcoidosis. Neurosarcoidosis can cause a multitude of symptoms and can mimic various diseases. A rare manifestation is bone marrow involvement. We describe a case of spinal cord syndrome due to myelopathy that was caused by sarcoidosis of the bone marrow. Case Presentation: A male patient presented to our hospital with incomplete spinal cord syndrome. He suffered from numbness of the legs which had progressed to severe paraparesis. Magnetic resonance imaging revealed thoracic myelopathy without contrast enhancement. Thorough diagnostics found no explanation for the myelopathy, and the patient was treated symptomatically with high-dose steroids. When the patient developed non-resolving leukopenia, a bone marrow biopsy was performed. The bone marrow showed changes due to sarcoidosis. Further testing revealed myocardial involvement of the sarcoidosis. The patient was started on oral prednisolone and methotrexate. Over the course of time, his symptoms improved, but he still suffers from spastic leg paresis and needs aids to walk farther than 1 kilometre. Conclusion: In patients presenting with neurological deficits of unknown cause, neurosarcoidosis is a potential explanation. If it manifests primarily in the bone marrow, the diagnosis can be easily overlooked. Abnormalities in a full blood count should make the treating physician consider this diagnosis, and a bone marrow biopsy should be performed.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Eva Schulz
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.,Department of Internal Medicine, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Omar AlhajOmar
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Tobias Struffert
- Department of Neuroradiology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Stefan Gattenloehner
- Department of Pathology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Mesut Yeniguen
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
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Kiyat P, Palamar M, Gerceker Turk B. Dry eye and Meibomian gland dysfunction evaluation in sarcoidosis patients. Eur J Ophthalmol 2021; 32:11206721211006579. [PMID: 33832342 DOI: 10.1177/11206721211006579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze the relation between Meibomian gland dysfunction, dry eye, and sarcoidosis. MATERIALS AND METHODS Twenty eyes of 10 sarcoidosis patients (Group 1) and 20 left eyes of 20 age-sex matched healthy volunteers (Group 2) were included. Presence of dry eye was evaluated with Schirmer 1 test, tear film break-up time (T-BUT), Oxford scale scoring, Ocular Surface Disease Index (OSDI) score assessments. A slit-lamp biomicroscope infrared filter (Topcon, SL-D701, IJssel, The Netherlands) was used to evaluate Meibomian glands. The drop-out ratio according to meibography was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area >2/3 of the total Meibomian gland area). RESULTS Among dry eye tests mean Schirmer 1 and T-BUT values were lower and OSDI score was higher in Group 1 compared to Group 2 and the differences were statistically significant (p = 0.017, p = 0.039, p = 0.003, respectively). In addition, the upper, lower and total meiboscores were statistically significantly higher in Group 1 (p = 0.047, p = 0.003, p = 0.005, respectively). CONCLUSION A significantly higher presence of dry eye and Meibomian gland drop out ratios was detected in sarcoidosis patients. It is important to monitor sarcoidosis patients for dry eye and Meibomian gland dysfunction and when detected, to treat adequately to prevent ocular surface damage.
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Affiliation(s)
- Pelin Kiyat
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Bengu Gerceker Turk
- Department of Dermatology, Ege University Faculty of Medicine, Izmir, Turkey
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Fomin VV, Brovko MY, Kalashnikov MV, Sholomova VI, Rozina TP, Akulkina LA, Pershina AE, Yanakayeva AS, Nekrasova TP. Hepatic involvement in sarcoidosis. TERAPEVT ARKH 2019; 91:8-16. [PMID: 31094470 DOI: 10.26442/00403660.2019.04.000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Liver is frequently involved in the pathological process. Wide range of clinical manifestations can be seen: from asymptomatic lesion with normal liver function tests to cirrhosis with portal hypertension. Biopsy plays the key role in diagnosis of the hepatic sarcoidosis. It is essential for morphological diagnosis to exclude other causes of granulomatous liver disease, most often - primary biliary cholangitis. Nowadays there are no standard treatment protocols for patients with hepatic sarcoidosis.
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Affiliation(s)
- V V Fomin
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Faculty of Medicine, Department of Internal Medicine No.1, Moscow, Russia
| | - M Yu Brovko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia
| | - M V Kalashnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Medical and Preventive Faculty, Department of Internal, Occupational Diseases and Rheumatology, Moscow, Russia
| | - V I Sholomova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Medical and Preventive Faculty, Department of Internal, Occupational Diseases and Rheumatology, Moscow, Russia
| | - T P Rozina
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia.,M.V. Lomonosov Moscow State University, Faculty of Base Medicine, Department of Internal Medicine, Moscow, Russia
| | - L A Akulkina
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia
| | - A E Pershina
- M.V. Lomonosov Moscow State University, Faculty of Base Medicine, Department of Internal Medicine, Moscow, Russia
| | - A Sh Yanakayeva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), E.M. Tareev Clinic of Internal Diseases, Moscow, Russia
| | - T P Nekrasova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), A.I. Strukov Department of Pathological Anatomy, Moscow, Russia
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Current management of sarcoidosis I: pulmonary, cardiac, and neurologic manifestations. Curr Opin Rheumatol 2019; 30:243-248. [PMID: 29389828 DOI: 10.1097/bor.0000000000000489] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Sarcoidosis is a systemic disease characterized by noncaseating granulomatous inflammation of multiple organ systems. Pulmonary, cardiac, and neurologic involvements have the worst prognosis. Current recommendations for the therapeutic management and follow-up of sarcoidosis involving these critical organs will be reviewed. RECENT FINDINGS In those sarcoidosis patients requiring immunosuppressive therapy, corticosteroids are used first at varying doses depending on the presenting manifestation. Patients with symptomatic pulmonary, cardiac, or neurologic involvement will be maintained on corticosteroids for at least a year. Many require a second immunosuppressive agent with methotrexate used most commonly. Anti-tumor necrosis factor agents, especially infliximab, are effective and recommendations for their use have been proposed. SUMMARY Evidence-based treatment guidelines do not exist for most sarcoidosis clinical manifestations. Therefore, clinical care of these patients must rely on expert opinion. Patients are best served by a multidisciplinary approach to their care. Future research to identify environmental triggers, genetic associations, biomarkers for treatment response, and where to position new steroid-sparing immunosuppressive agents is warranted.
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Peña-Garcia JI, Shaikh S, Barakoti B, Papageorgiou C, Lacasse A. Bone marrow involvement in sarcoidosis: an elusive extrapulmonary manifestation. J Community Hosp Intern Med Perspect 2019; 9:150-154. [PMID: 31061693 PMCID: PMC6487444 DOI: 10.1080/20009666.2019.1575688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/25/2019] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is a granulomatous disease with various extrapulmonary manifestations. We describe a 51-year-old African American woman with a history of cutaneous sarcoidosis admitted with bicytopenia. Suspicion for systemic sarcoidosis was established after contrast-enhanced computerized tomography of the chest, abdomen and pelvis showed a pulmonary nodule, diffuse lymphadenopathy and hepatosplenomegaly. Cytopenias in sarcoidosis, when present, may reflect bone marrow infiltration. Hence, biopsy was obtained and bone marrow sarcoidosis was diagnosed. This manifestation, in spite of ethnic and gender predilection, is rarely seen. As with other forms of sarcoidosis, treatment comprises of corticosteroids. Abbreviations: ANCA: Antineutrophil cytoplasmic antibody; BM: Bone marrow; BMS: Bone marrow sarcoidosis; CT: Computerized tomography; HIV: Human immunodeficiency virus; HLA: Human leukocyte antigen; MRI: Magnetic resonance imaging
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Affiliation(s)
- J Isaac Peña-Garcia
- Geriatric Research Education and Clinical Center, Miami VA/Jackson Memorial Hospital, Miami, FL, USA
| | - Sana Shaikh
- Department of Internal Medicine, SSM St. Mary's Hospital - St. Louis, St. Louis, MO, USA
| | - Bhishma Barakoti
- Department of Internal Medicine, SSM St. Mary's Hospital - St. Louis, St. Louis, MO, USA
| | | | - Alexandre Lacasse
- Department of Internal Medicine, SSM St. Mary's Hospital - St. Louis, St. Louis, MO, USA
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Affiliation(s)
- Claudio Tana
- Internal Medicine and Critical Subacute Care Unit Medicine Geriatric-Rehabilitation Department University-Hospital of Parma Via Antonio Gramsci 14 43126, Parma, Italy
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Vidal M, Alvarado A, López J, Sierra J, Ruíz A. Scar sarcoidosis: A rare entity found by 18F-FDG-PET/CT. Radiol Case Rep 2018; 13:1216-1219. [PMID: 30233763 PMCID: PMC6141697 DOI: 10.1016/j.radcr.2018.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/10/2023] Open
Abstract
18F-labeled fluoro-2-positron deoxyglucose emission tomography/computed tomography has been widely used in malignancy assessment, however, is not tumor-specific and may be taken up by non-malignant conditions such as sarcoidosis. Sarcoidosis is a systemic inflammatory disorder and scar sarcoidosis is a rare manifestation of the disease. A 60-year-old man with a past medical history of synchronous colon adenocarcinoma and clear cell renal cell carcinoma with clinical suspicion of tumor recurrence. 18F-labeled fluoro-2-positron deoxyglucose emission tomography/computed tomography scan demonstrated lesions with increased fluorodeoxyglucose uptake in mediastinal and left supraclavicular lymph nodes, along with hypermetabolic cutaneous foci that corresponded with previous surgical scars. Skin biopsy was suggestive of sarcoidosis.
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Affiliation(s)
- M Vidal
- Nuclear Medicine and Radiology Department of the Pablo Tobón Uribe Hospital, Medellín, Colombia
| | - A Alvarado
- Radiology Resident at CES University, Medellín, Colombia
| | - J López
- Nuclear Medicine and Radiology Department of the Pablo Tobón Uribe Hospital, Medellín, Colombia
| | - J Sierra
- Gastroenterology Department of the Pablo Tobón Uribe Hospital, Medellín, Colombia
| | - A Ruíz
- Pathology Department of the Pablo Tobón Uribe Hospital, Medellín, Colombia
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Ungprasert P, Crowson CS, Carmona EM, Matteson EL. Outcome of pulmonary sarcoidosis: a population-based study 1976-2013. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:123-128. [PMID: 32476891 DOI: 10.36141/svdld.v35i2.6356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/24/2017] [Indexed: 11/02/2022]
Abstract
Background: A hallmark of sarcoidosis is lung disease. However, the prognosis and long-term outcome of pulmonary sarcoidosis are not well-defined due to the limited number of studies with long duration of follow-up. Objectives: This study was undertaken to characterize the course of pulmonary sarcoidosis in a population-based cohort. Methods: A population-based cohort of 311 incident cases of pulmonary sarcoidosis among Olmsted County, Minnesota residents in 1976-2013 were identified. Medical records of the confirmed cases were reviewed from diagnosis to last follow-up. Data on stage of pulmonary sarcoidosis at diagnosis, serial pulmonary function tests, requirement of oxygen therapy and treatment were abstracted. The cumulative incidence of chronic respiratory impairment (defined as forced vital capacity of <50%, diffuse capacity for carbon monoxide of <40% or requirement to use oxygen supplementation) adjusted for the competing risk of death was estimated. Cox models were used to assess the association of stage of pulmonary sarcoidosis and treatment on the development of chronic respiratory impairment. Results: 25 patients developed chronic respiratory impairment which corresponded to a 10-year event rate of 4.4% (95% confidence interval [CI], 1.9.-6.9). Stage of pulmonary sarcoidosis at diagnosis was a strong predictor for chronic respiratory impairment with hazard ratio compared with stage I of 5.29 (95% CI, 1.65-16.96) for stage II and 8.36 (95% CI, 26.3-26.52) for stage III and IV. Use of glucocorticoids and immunosuppressive agents was associated with a significantly increased risk of chronic respiratory impairment. Conclusion: Patients with pulmonary sarcoidosis have a good pulmonary prognosis with a low incidence of chronic respiratory impairment. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 123-128).
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA.,Division of Rheumatology, Department of Medicine, Faculty of medicine Siriraj hospital, Mahidol University, Bangkok, Thailand
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, USA
| | - Eva M Carmona
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, USA
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Abstract
Mikulicz Syndrome (MS) is a rare chronic condition characterized by the abnormal enlargement of glandular tissue in the head and neck. Patients usually present with enlarged lacrimal and parotid glands. While this can be a benign self-limiting condition, other complex systemic diseases, such as sarcoidosis, may represent other underlying etiologies. We present a case of MS in a patient with a history of Crohn's disease.
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Affiliation(s)
- Dinesh Rao
- Department of Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Patrick Natter
- Department of Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Zhiqiang Brad Wang
- Department of Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Sukhwinder Johnny Singh Sandhu
- Department of Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
- Department of Neurology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
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Clinical Characteristics and Outcome of Hepatic Sarcoidosis: A Population-Based Study 1976-2013. Am J Gastroenterol 2017; 112:1556-1563. [PMID: 28872150 PMCID: PMC5629110 DOI: 10.1038/ajg.2017.231] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Data on clinical manifestations and outcome of hepatic sarcoidosis are scarce. This study aimed to use a population-based cohort of patients with incident sarcoidosis to better describe the characteristics of hepatic sarcoidosis. METHODS A cohort of incident cases of sarcoidosis in Olmsted County, MN, USA, from 1976 to 2013 was identified from the database. Diagnosis was verified by individual medical record review. Confirmed cases of sarcoidosis were then reviewed for liver involvement. Data on clinical manifestations, imaging study, liver biochemical tests, treatment, and outcome were collected. Cumulative incidence of cirrhosis adjusted for the competing risk of death was estimated. RESULTS A total of 345 cases of incident sarcoidosis were identified. Of these, 19 cases (6%) had liver involvement (mean age 46.1 years, 53% female and 79% Caucasian). Most patients had asymptomatic liver disease and were discovered in pursuit of abnormal biochemical tests and imaging studies. Alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) were elevated in the majority of patients (88 and 90%, respectively). Elevated transaminases were less common and less severe. About half of patients had abnormal imaging study with hypodense nodular lesions being the most common abnormality (six patients) followed by hepatomegaly (three patients). Liver biopsy revealed non-caseating granuloma in 88% (14 of 16 patients). A total of four patients developed cirrhosis. CONCLUSIONS Involvement of the liver by sarcoidosis was seen in 6% of patients with sarcoidosis. The majority of patients were asymptomatic. Elevated ALP and GGT were the most common abnormal biochemical tests. Liver biopsy revealed non-caseating granuloma in almost all cases. Cirrhosis was seen in a significant number of patients. Generalizability of the observations to other populations may be limited, as the studied population was predominantly Caucasian. The prevalence of liver disease may be higher in more diverse populations.
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Hyperfixations osseuses au TEP et hypercalcémie : métastases osseuses ou sarcoïdose ? Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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ASSOCIAÇÃO DE LÚPUS ERITEMATOSO SISTÊMICO E SARCOIDOSE GANGLIONAR. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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