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El Jammal T, Jamilloux Y, Gerfaud-Valentin M, Richard-Colmant G, Weber E, Bert A, Androdias G, Sève P. Challenging Mimickers in the Diagnosis of Sarcoidosis: A Case Study. Diagnostics (Basel) 2021; 11:diagnostics11071240. [PMID: 34359324 PMCID: PMC8304686 DOI: 10.3390/diagnostics11071240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown cause characterized by a wide variety of presentations. Its diagnosis is based on three major criteria: a clinical presentation compatible with sarcoidosis, the presence of non-necrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. Many conditions may mimic a sarcoid-like granulomatous reaction. These conditions include infections, neoplasms, immunodeficiencies, and drug-induced diseases. Moreover, patients with sarcoidosis are at risk of developing opportunistic infections or lymphoma. Reliably confirming the diagnosis of sarcoidosis and better identifying new events are major clinical problems in daily practice. To address such issues, we present seven emblematic cases, seen in our department, over a ten-year period along with a literature review about case reports of conditions misdiagnosed as sarcoidosis.
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Affiliation(s)
- Thomas El Jammal
- Department of Internal Medicine, Lyon University Hospital, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.); (G.R.-C.); (E.W.); (A.B.)
| | - Yvan Jamilloux
- Department of Internal Medicine, Lyon University Hospital, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.); (G.R.-C.); (E.W.); (A.B.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Lyon University Hospital, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.); (G.R.-C.); (E.W.); (A.B.)
| | - Gaëlle Richard-Colmant
- Department of Internal Medicine, Lyon University Hospital, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.); (G.R.-C.); (E.W.); (A.B.)
| | - Emmanuelle Weber
- Department of Internal Medicine, Lyon University Hospital, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.); (G.R.-C.); (E.W.); (A.B.)
| | - Arthur Bert
- Department of Internal Medicine, Lyon University Hospital, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.); (G.R.-C.); (E.W.); (A.B.)
| | - Géraldine Androdias
- Department of Neurology, Service Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon University Hospital, F-69677 Bron, France;
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.); (G.R.-C.); (E.W.); (A.B.)
- Research on Healthcare Performance (RESHAPE), INSERM U1290, 69373 Lyon, France
- Correspondence: ; Tel.: +33-426-732-636
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Ghrenassia E, Mekinian A, Chapelon-Albric C, Levy P, Cosnes J, Sève P, Lefèvre G, Dhôte R, Launay D, Prendki V, Morell-Dubois S, Sadoun D, Mehdaoui A, Soussan M, Bourrier A, Ricard L, Benamouzig R, Valeyre D, Fain O. Digestive-tract sarcoidosis: French nationwide case-control study of 25 cases. Medicine (Baltimore) 2016; 95:e4279. [PMID: 27442665 PMCID: PMC5265782 DOI: 10.1097/md.0000000000004279] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 12/21/2022] Open
Abstract
Digestive tract sarcoidosis (DTS) is rare and case-series are lacking. In this retrospective case-control study, we aimed to compare the characteristics, outcome, and treatment of patients with DTS, nondigestive tract sarcoidosis (NDTS), and Crohn disease.We included cases of confirmed sarcoidosis, symptomatic digestive tract involvement, and noncaseating granuloma in any digestive tract. Each case was compared with 2 controls with sarcoidoisis without digestive tract involvement and 4 with Crohn disease.We compared 25 cases of DTS to 50 controls with NDTS and 100 controls with Crohn disease. The major digestive clinical features were abdominal pain (56%), weight loss (52%), nausea/vomiting (48%), diarrhea (32%), and digestive bleeding (28%). On endoscopy of DTS, macroscopic lesions were observed in the esophagus (9%), stomach (78%), duodenum (9%), colon, (25%) and rectum (19%). As compared with NDTS, DTS was associated with weight loss (odds ratio [OR] 5.8; 95% confidence interval [CI] 1.44-23.3) and the absence of thoracic adenopathy (OR 5.0; 95% CI 1.03-25). As compared with Crohn disease, DTS was associated with Afro-Caribbean origin (OR 27; 95% CI 3.6-204) and the absence of ileum or colon macroscopic lesions (OR 62.5; 95% CI 10.3-500). On the last follow-up, patients with DTS showed no need for surgery (versus 31% for patients with Crohn disease; P = 0.0013), and clinical digestive remission was frequent (76% vs. 35% for patients with Crohn disease; P = 0.0002).The differential diagnosis with Crohn disease could be an issue with DTS. Nevertheless, the 2 diseases often have different clinical presentation and outcome.
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Affiliation(s)
- Etienne Ghrenassia
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Arsene Mekinian
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Catherine Chapelon-Albric
- APHP, Hôpital Pitié-Salpétrière, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne
| | - Pierre Levy
- APHP, Hôpital Tenon, Sorbonne Universités, UPMC Université Paris 06, Public health department
| | - Jacques Cosnes
- APHP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de gastro-entérologie, Paris
| | - Pascal Sève
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, department of internal medicine, F-Lyon. University Claude Bernard Lyon 1, F-69100, Villeurbanne
| | | | - Robin Dhôte
- APHP, Hôpital Avicenne, service de médecine interne, université Paris 13, Bobigny, France
| | - David Launay
- Hôpital Claude Huriez, service de médecine interne, Lille, France
| | - Virginie Prendki
- Department of internal medicine, Division of internal medicine and rehabilitation, rehabilitation and geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Danielle Sadoun
- APHP, Hôpital Avicenne, Université Paris 13, service de pneumologie, Bobigny
| | | | - Michael Soussan
- APHP, Hôpital Avicenne, Université Paris 13, service de médecine nucléaire
| | - Anne Bourrier
- APHP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de gastro-entérologie, Paris
| | - Laure Ricard
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Robert Benamouzig
- APHP, Hôpital Avicenne, Université Paris 13, service de gastro-entérologie, Bobigny, France
| | - Dominique Valeyre
- APHP, Hôpital Avicenne, Université Paris 13, service de pneumologie, Bobigny
| | - Olivier Fain
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
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Improvement with infliximab of a disseminated sarcoidosis in a patient with Crohn's disease. Case Rep Pulmonol 2014; 2014:368780. [PMID: 24653848 PMCID: PMC3932721 DOI: 10.1155/2014/368780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/31/2013] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis and Crohn's disease are systemic granulomatous disorders affecting the lung and the intestine, respectively, with variable involvement of other organs and are seldom associated. While anti-TNF α is a recognized treatment of Crohn's disease, its usage is discussed in sarcoidosis. A 42-year-old man presented with an 11-year-long history of Crohn's disease; upon discovery of an abnormal chest CT scan the diagnosis of multivisceral sarcoidosis was made and, later, a treatment with an anti-TNF α agent, infliximab, was started, because of worsening Crohn's disease recurrences. CT scan demonstrated net regression of pulmonary opacities and hepatosplenic lesions. Pathologies obtained from the intestinal tract and the bronchi of the patient were, respectively, characteristic of Crohn's disease and sarcoidosis leading to the diagnosis of both diseases. We report a rare case of steroid resistant Crohn's disease associated with multivisceral sarcoidosis, treated successfully by an anti-TNF α agent, infliximab.
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