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Brazile TL, Saul M, Nouraie SM, Gibson K. Characteristics and survival of patients diagnosed with cardiac sarcoidosis: A case series. Front Med (Lausanne) 2022; 9:1051412. [PMID: 36582282 PMCID: PMC9792839 DOI: 10.3389/fmed.2022.1051412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Sarcoidosis is a multiorgan system granulomatous disease of unknown etiology. It is hypothesized that a combination of environmental, occupational, and/or infectious factors provoke an immunological response in genetically susceptible individuals, resulting in a diversity of manifestations throughout the body. In the United States, cardiac sarcoidosis (CS) is diagnosed in 5% of patients with systemic sarcoidosis, however, autopsy results suggest that cardiac involvement may be present in > 50% of patients. CS is debilitating and significantly decreases quality of life and survival. Currently, there are no gold-standard clinical diagnostic or monitoring criteria for CS. Methods We identified patients with a diagnosis of sarcoidosis who were seen at the Simmons Center from 2007 to 2020 who had a positive finding of CS documented with cardiovascular magnetic resonance (CMR) and/or endomyocardial biopsy as found in the electronic health record. Medical records were independently reviewed for interpretation and diagnostic features of CS including late gadolinium enhancement (LGE) patterns, increased signal on T2-weighted imaging, and non-caseating granulomas, respectively. Extracardiac organ involvement, cardiac manifestations, comorbid conditions, treatment history, and vital status were also abstracted. Results We identified 44 unique patients with evidence of CS out of 246 CMR reports and 9 endomyocardial biopsy pathology reports. The first eligible case was diagnosed in 2007. The majority of patients (73%) had pulmonary manifestations, followed by hepatic manifestations (23%), cutaneous involvement (23%), and urolithiasis (20%). Heart failure was the most common cardiac manifestation affecting 59% of patients. Of these, 39% had a documented left ventricular ejection fraction of < 50% on CMR. Fifty eight percent of patients had a conduction disease and 44% of patients had documented ventricular arrhythmias. Pharmacotherapy was usually initiated for extracardiac manifestations and 93% of patients had been prescribed prednisone. ICD implantation occurred in 43% of patients. Patients were followed up for a median of 5.4 (IQR: 2.4-8.5) years. The 10-year survival was 70%. In addition to age, cutaneous involvement was associated with an increased risk of death (age-adjusted OR 8.47, 95% CI = 1.11-64.73). Conclusion CMR is an important tool in the non-invasive diagnosis of CS. The presence of LGE on CMR in a pattern consistent with CS has been shown to be a predictor of mortality and likely contributed to a high proportion of patients undergoing ICD implantation to decrease risk of sudden cardiac death. Clinical implications Additional studies are necessary to develop robust criteria for the diagnosis of CS with CMR, assess the benefit of serial imaging for disease monitoring, and evaluate the effect of immunosuppression on disease progression.
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Affiliation(s)
- Tiffany L. Brazile
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Melissa Saul
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Seyed Mehdi Nouraie
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States
| | - Kevin Gibson
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States,*Correspondence: Kevin Gibson,
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Jaiswal V, Ang SP, Sarfraz Z, Butey S, Khandait HV, Song D, Chia JE, Maroo D, Hanif M, Ghanim M, Chand R, Biswas M. RETRACTED: Association between sarcoidosis and cardiovascular Outcomes: A systematic review and Meta-analysis. IJC HEART & VASCULATURE 2022; 41:101073. [PMID: 35800042 PMCID: PMC9253999 DOI: 10.1016/j.ijcha.2022.101073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022]
Abstract
What is known? Previous studies showed the prevalence of cardiovascular diseases with sarcoidosis. However, there is limited data quantifying the future risks of these adverse outcomes in patients with a diagnosis of sarcoidosis. What is New? To the best of our knowledge, this is the first meta-analysis assessed the adverse cardiovascular outcomes in patients with sarcoidosis. Our study analyzed 22,539,096 patients and found that the incidence of Atrial Arrhythmia, Ventricular Tachycardia and Heart Failure were significantly higher in patients with sarcoidosis. All-cause mortality appeared to be approximately 2-fold higher in patients with sarcoidosis. What are the clinical implications? In sarcoidosis with cardiac involvement, clinicians should be aware of the increased risk of adverse cardiovascular events in these patients. Additional studies are warranted to study the optimal management approach towards patients with cardiac sarcoidosis.
Background Sarcoidosis is a chronic inflammatory disorder of unknown etiology associated with high morbidity and mortality. Its association with cardiovascular outcomes is under-documented. Aim The aim of this study was to assess the adverse cardiovascular outcomes in patients with sarcoidosis compared with that of non-sarcoidosis. Methodology Online databases including PubMed, Embase and Scopus were queried from inception until March 2022. The outcomes assessed included all-cause mortality (ACM) and incidence of ventricular tachycardia (VT), heart failure (HF) and atrial arrhythmias (AA). Result A total of 6 studies with 22,539,096 participants (42,763 Sarcoidosis, 22,496,354 Non-Sarcoidosis) were included in this analysis. The pooled prevalence of sarcoidosis was 13.1% (95% CI 1% to 70%). The overall mean age was 47 years. The most common comorbidities were hypertension (12.7% vs 12.5%), and diabetes mellitus (5.5% vs 4%) respectively. The pooled analysis of primary endpoints showed that all-cause mortality (RR, 2.08; 95% CI: 1.17 to 3.08; p = 0.01) was significantly increased in sarcoidosis patients. The pooled analysis of secondary endpoints showed that the incidence of VT (RR, 15.3; 95% CI: 5.39 to 43.42); p < 0.001), HF (RR, 4.96; 95% CI: 2.02 to 12.14; p < 0.001) and AA (RR, 2.55; 95% CI: 1.47 to 4.44); p = 0.01) were significantly higher with sarcoidosis respectively compared to non-sarcoidosis. Conclusion Incidence of VT, HF and AA was significantly higher in patients with CS. Clinicians should be aware of these adverse cardiovascular events associated with sarcoidosis.
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Castro MDC, Pereira CADC. Nonlife-Threatening Sarcoidosis. Semin Respir Crit Care Med 2020; 41:733-740. [PMID: 32777854 DOI: 10.1055/s-0040-1710371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology. The outcome is quite variable and is mainly related to persistent inflammatory processes and the development of fibrosis. Many prognostic factors have been described, but the disease evolution is not yet entirely known. The nonthreatening course is characterized by spontaneous involution or stability after treatment withdrawal. Löfgren's syndrome is a subset within the spectrum of sarcoidosis phenotypes, composed of acute onset of fever, bilateral hilar lymphadenopathy, erythema nodosum and/or bilateral ankle periarticular inflammation/arthritis, specifically characterized by a self-limiting disease course. In contrast, advanced fibrotic sarcoidosis with pulmonary hypertension phenotype is correlated with a poor prognosis. Further studies are necessary to detail phenotypes to better understand the mechanisms of the disease and plan future clinical therapeutic studies.
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Affiliation(s)
- Marina Dornfeld Cunha Castro
- Department of Medicine, Division of Respiratory Diseases, Interstitial Lung Diseases Center, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Carlos Alberto de Castro Pereira
- Department of Medicine, Division of Respiratory Diseases, Interstitial Lung Diseases Center, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Milojevic IG, Sobic-Saranovic D, Petrovic N, Beatovic S, Tadic M, Artiko VM. Hybrid Imaging in Evaluation of Abdominal Sarcoidosis. Curr Med Imaging 2020; 15:26-31. [PMID: 31964324 DOI: 10.2174/1573405614666180531111616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 09/03/2017] [Accepted: 04/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence of abdominal involvement, distribution pattern and evaluate role of hybrid molecular imaging in patients with abdominal sarcoidosis. METHODS Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination. Active disease was found in 82 patients, and they all were screened for the presence of abdominal sarcoidosis on FDG PET/CT. All patients also underwent MDCT and assessment of serum ACE level. Follow up FDG PET/CT examination was done 12.3±5.4 months after the baseline. RESULTS Abdominal sarcoidosis was present in 31/82 patients with active sarcoidosis. FDG uptake was present in: retroperitoneal lymph nodes (77%), liver (26%), spleen (23%), adrenal gland (3%). Majority of patients had more than two locations of disease. Usually thoracic disease was spread into the extrathoracic localizations, while isolated abdominal sarcoidosis was present in 10% of patients. After first FDG PET/CT examination therapy was changed in all patients. Eleven patients came to the follow up examination where SUVmax significantly decreased in the majority of them. Three patients had total remission, three had absence of abdominal disease but discrete findings in thorax and others had less spread disease. ACE levels did not correlate with SUVmax level. CONCLUSION FDG PET/CT can be a useful tool for detection of abdominal sarcoidosis and in the evaluation of therapy response in these patients. Awareness of the presence of intra-abdominal sarcoidosis is important in order to prevent long-standing unrecognized disease.
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Affiliation(s)
| | | | | | | | - Marijana Tadic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vera M Artiko
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Agre K, McCarthy Veach P, Bemmels H, Wiens K, LeRoy BS, Hordinsky M. Familial implications of autoimmune disease: Recurrence risks of alopecia areata and associated conditions in first-degree relatives. J Genet Couns 2019; 29:35-43. [PMID: 31605426 DOI: 10.1002/jgc4.1178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 11/11/2022]
Abstract
Alopecia areata (AA), a complex autoimmune hair loss condition, affects approximately 2.1% of the population. Individuals with AA have increased susceptibility to diseases such as atopy and autoimmune disorders, but little is known about first-degree relatives' risk to develop AA and associated conditions. Genetic counseling for multifactorial conditions, including autoimmune disease is complex, but potentially valuable. Anecdotally we know patients with AA ask medical providers about recurrence risk for family members as well as question whether they and their relatives are at risk for other conditions. Data on AA recurrence risks and comorbid conditions among relatives of affected individuals comprise valuable information that may guide clinical management by genetic counselors. This study investigated the recurrence risk of AA and compared the prevalence of associated conditions among first-degree relatives to the general population. The study also assessed the validity of self-reported conditions for a subset of participants. Relatives of individuals with AA (N = 155), recruited from the National Alopecia Areata Foundation Registry, completed telephone surveys about their personal medical history for 70 medical conditions associated with AA. Medical records for 60 participants were compared to self-reported responses. One-sided proportional tests, in which it is assumed the disease prevalence in first-degree relatives is higher than for those in the general population, yielded a 7.8% estimated risk of AA versus the general population prevalence of 2.1%. Furthermore, there are increased risks of 33 associated conditions, including atopy and other autoimmune conditions. Comparison of medical reports to self-reported conditions indicated only 12% was incongruent. The findings may help genetic counselors better serve patients and their families by informing them of lifetime risk estimates of developing AA and comorbid conditions, resulting in early diagnosis of autoimmune diseases in AA families. Findings also provide evidence supporting the validity of self-report data in AA families.
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Affiliation(s)
- Katherine Agre
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Patricia McCarthy Veach
- Department of Genetics, Cell Biology, and Development, Institute of Human Genetics, University of Minnesota, Minneapolis, MN, USA
| | - Heather Bemmels
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | | | - Bonnie S LeRoy
- Department of Genetics, Cell Biology, and Development, Institute of Human Genetics, University of Minnesota, Minneapolis, MN, USA
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota Health, Minneapolis, MN, USA
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Grozdic Milojevic I, Tadic M, Sobic-Saranovic D, Saponjski J, Artiko VM. Hybrid Imaging in Head and Neck Sarcoidosis. J Clin Med 2019; 8:E803. [PMID: 31195715 PMCID: PMC6617001 DOI: 10.3390/jcm8060803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 12/19/2022] Open
Abstract
Abstract: To determine the prevalence of head and neck sarcoidosis (HNS) and evaluate the role of hybrid molecular imaging in HNS. Between 2010 and 2018, 222 patients with chronic sarcoidosis and presence of prolonged symptoms of active disease were referred to FDG PET/CT. Active disease was found in 169 patients, and they were all screened for the presence of HNS. All patients underwent MDCT and assessment of the serum ACE level. Follow-up FDG PET/CT examination was done 19.84 ± 8.98 months after the baseline. HNS was present in 38 out of 169 patients. FDG uptake was present in: cervical lymph nodes (38/38), submandibular glands (2/38), cerebrum (2/38), and bone (1/38). The majority of patients had more than two locations of disease. After FDG PET/CT examination, therapy was changed in most patients. Fourteen patients returned to follow-up FDG PET/CT examination in order to assess the therapy response. PET/CT revealed active disease in 12 patients and complete remission in two patients. Follow-up ACE levels had no correlation with follow-up SUVmax level (ρ = -0.18, p = 0.77). FDG PET/CT can be useful in the detection of HNS and in the evaluation of the therapy response. It may replace the use of non-purposive mounds of insufficiently informative laboratory and radiological procedures.
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Affiliation(s)
- Isidora Grozdic Milojevic
- Center for Nuclear Medicine, Clinical Center of Serbia, 11000 Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Dragana Sobic-Saranovic
- Center for Nuclear Medicine, Clinical Center of Serbia, 11000 Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Jelena Saponjski
- Center for Nuclear Medicine, Clinical Center of Serbia, 11000 Belgrade, Serbia.
| | - Vera M Artiko
- Center for Nuclear Medicine, Clinical Center of Serbia, 11000 Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
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Webb M, Conway KS, Ishikawa M, Diaz F. Cardiac Involvement in Sarcoidosis Deaths in Wayne County, Michigan: A 20-Year Retrospective Study. Acad Forensic Pathol 2018; 8:718-728. [PMID: 31240066 PMCID: PMC6490587 DOI: 10.1177/1925362118797744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sarcoidosis is a disease of unknown etiology characterized by the formation of noncaseating, nonnecrotizing granulomas in various organ systems. METHODS Reviews of 84 cases of natural death with sarcoidosis between the years 1996 and 2017 autopsied at Wayne County. RESULTS The median age of decedents was 44 years (29 - 59 years of age). Blacks comprised 95% of the cohort, and 52% were female. Sarcoidosis or direct sequelae were the cause of death in 79% of cases. Twenty-nine percent of patients had a documented history of sarcoidosis and 70% of patients had evidence of systemic sarcoidosis. The most common sites of involvement were lungs or hilar lymph nodes (92%), heart (45%), liver (39%), and spleen (30%). Decedents with cardiac involvement were more likely to have no documented history of sarcoidosis (87% vs. 59%, p=0.004), more likely to have died of a sarcoidosis-related cause (97% vs. 65%, p<0.001), and died at a younger mean age (41 years vs. 46 years, p=0.001). In addition, individuals with cardiac involvement commonly had concurrent multiorgan involvement including lungs (90%), lymph nodes (38%), liver (40%), spleen (32%), and kidneys (7%). CONCLUSIONS Cardiac sarcoidosis is a uniquely poor prognostic factor and carries an increased risk of sudden death as shown by a disproportionate representation among medical examiner cases of sarcoidosis. Our findings suggest that approximately 40% may have asymptomatic cardiac involvement. The distribution of sarcoidosis within our cohort suggests that there is potentially a large undiagnosed and/or underdiagnosed demographic within large urban centers, such as Detroit, Michigan.
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Affiliation(s)
- Milad Webb
- Milad Webb MD PhD, 1301 Catherine Street 5231E Medical Science Bldg I Ann Arbor Michigan 48109-5602,
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Parisi MT, Otjen JP, Stanescu AL, Shulkin BL. Radionuclide Imaging of Infection and Inflammation in Children: a Review. Semin Nucl Med 2017; 48:148-165. [PMID: 29452618 DOI: 10.1053/j.semnuclmed.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the exception of radiolabeled monoclonal antibodies, antibody fragments and radiolabeled peptides which have seen little application in the pediatric population, the nuclear medicine imaging procedures used in the evaluation of infection and inflammation are the same for both adults and children. These procedures include (1) either a two- or a three-phase bone scan using technetium-99m methylene diphosphonate; (2) Gallium 67-citrate; (3) in vitro radiolabeled white blood cell imaging (using 111Indium-oxine or 99mTechnetium hexamethyl-propylene-amine-oxime-labeled white blood cells); and (4) hybrid imaging with 18F-FDG. But children are not just small adults. Not only are the disease processes encountered in children different from those in adults, but there are developmental variants that can mimic, but should not be confused with, pathology. This article discusses some of the differences between adults and children with osteomyelitis, illustrates several of the common developmental variants that can mimic disease, and, finally, focuses on the increasing use of 18F-FDG PET/CT in the diagnosis and response monitoring of children with infectious and inflammatory processes. The value of and need for pediatric specific imaging protocols are reviewed.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA.; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA..
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - A Luana Stanescu
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
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Adam T, Mazilu L, Craciun L, Anton A, Iliescu D, Tofolean D. Unusual Presentation Of Sarcoidosis: Case Report. ARS MEDICA TOMITANA 2017. [DOI: 10.1515/arsm-2017-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Sarcoidosis is a multisystem granulomatous disease with polymorphic manifestations, of unknown etiology, that can affect any organ in the body, but most commonly the lungs [1,2,3]. Extrapulmonary involvement is common, can occur in association with or in the absence of intrathoracic disease, and all organs can be involved, but it is rare to find an isolated extrapulmonary disease (less than 10% of patients) [3,4]. On occasion, the presentation of sarcoidosis may be atypical.
We report a case of systemic sarcoidosis, with particular clinical data: extrathoracic onset with subdiaphragmatic lymph nodes, hepatomegaly and splenomegaly.
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Affiliation(s)
- Tatiana Adam
- Department of Internal Medicine, County Emergency Clinical Hospital of Constanta Romania
- University “Ovidius” of Constanta, Faculty of Medicine, Romania
| | - Laura Mazilu
- Department of Oncology, County Emergency Clinical Hospital of Constanta Romania
- University “Ovidius” of Constanta, Faculty of Medicine, Romania
| | - L. Craciun
- Department of Internal Medicine, County Emergency Clinical Hospital of Constanta Romania
- University “Ovidius” of Constanta, Faculty of Medicine, Romania
| | - Adelina Anton
- Department of Internal Medicine, County Emergency Clinical Hospital of Constanta Romania
- University “Ovidius” of Constanta, Faculty of Medicine, Romania
| | - Dan Iliescu
- University “Ovidius” of Constanta, Faculty of Medicine, Romania
| | - Doina Tofolean
- Department of Internal Medicine, County Emergency Clinical Hospital of Constanta Romania
- University “Ovidius” of Constanta, Faculty of Medicine, Romania
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Kemal CT, Aylin OA, Volkan K, Seda M, Recep B, Can S. The importance of PET/CT findings and hematological parameters in prediction of progression in sarcoidosis cases. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:242-250. [PMID: 32476852 PMCID: PMC7170101 DOI: 10.36141/svdld.v34i3.5299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 01/23/2017] [Indexed: 12/02/2022]
Abstract
Aim: We aimed to reveal the correlation of NLR rate, RDW and MPV values and with the findings of PET/CT regarding the prediction of disease progression and the clinical characteristics. Materials and methods: The treatment naive sarcoidosis cases, of whose PET/CT have been taken due to mediastinal lymphadenopathy of whose diagnosis have been confirmed by biopsy, were included in the study. Hematological parameters, clinical, radiological and PET/CT findings are evaluated. Results: 40 sarcoidosis and 40 healthy control cases were included in the study. NLR, RDW, MPV and the sedimentation values in the sarcoidosis group were determined statistically significantly higher. In patients having parenchymal involvement in PET/CT, the values of FVC%, DLCO, DLCO%, DLCO/VA and DLCO/VA% were determined significantly lower. High NLR and PET/CT LAP SUVmax values and low DLCO% values are statistically significantly correlated with one-year disease progression. For predicting the progression, for the NLR cut-off value 3.20, the area under the curve was determined as 0.79 (CI 62.2-96.5), sensitivity as 80.0%, specificity as 76.7% and for the PET/CT SUVmax cut-off value 9.5, the area under the curve was determined as 0.71 (CI 46.6-95.9), sensitivity as 70.0%, specificity as 82.1%. Conclusion: We determined that the values observed in routine hematologic examinations such as NLR, RDW and MPV, were high in sarcoidosis cases. In addition, the values of NLR, DLCO% and PET/CT SUVmax might be used in predicting the progression. At the same, once again we showed that the lung parenchyma involvement in PET/CT correlates with many pulmonary function parameters. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 242-250)
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Affiliation(s)
- Can Tertemiz Kemal
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | | | - Karacam Volkan
- Thoracic Surgery, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Mersin Seda
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Bekis Recep
- Nuclear Medicine, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Sevinc Can
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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Hu Y, Yibrehu B, Zabini D, Kuebler WM. Animal models of sarcoidosis. Cell Tissue Res 2016; 367:651-661. [PMID: 27807704 DOI: 10.1007/s00441-016-2526-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Abstract
Sarcoidosis is a debilitating, inflammatory, multiorgan, granulomatous disease of unknown cause, commonly affecting the lung. In contrast to other chronic lung diseases such as interstitial pulmonary fibrosis or pulmonary arterial hypertension, there is so far no widely accepted or implemented animal model for this disease. This has hampered our insights into the etiology of sarcoidosis, the mechanisms of its pathogenesis, the identification of new biomarkers and diagnostic tools and, last not least, the development and implementation of novel treatment strategies. Over past years, however, a number of new animal models have been described that may provide useful tools to fill these critical knowledge gaps. In this review, we therefore outline the present status quo for animal models of sarcoidosis, comparing their pros and cons with respect to their ability to mimic the etiological, clinical and histological hallmarks of human disease and discuss their applicability for future research. Overall, the recent surge in animal models has markedly expanded our options for translational research; however, given the relative early stage of most animal models for sarcoidosis, appropriate replication of etiological and histological features of clinical disease, reproducibility and usefulness in terms of identification of new therapeutic targets and biomarkers, and testing of new treatments should be prioritized when considering the refinement of existing or the development of new models.
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Affiliation(s)
- Yijie Hu
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Cardiovascular Surgery, Institute of Surgical Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Betel Yibrehu
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Diana Zabini
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Wolfgang M Kuebler
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada. .,Departments of Surgery and Physiology, University of Toronto, Toronto, ON, Canada. .,Institute of Physiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Malignant disease as an incidental finding at ¹⁸F-FDG-PET/CT scanning in patients with granulomatous lung disease. Nucl Med Commun 2015; 36:430-7. [PMID: 25646704 DOI: 10.1097/mnm.0000000000000274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Fluorine-18 fluorodeoxyglucose (¹⁸F-FDG)-PET/computed tomography (CT) is used for assessment of the extent and activity of disease in patients with inflammatory granulomatous lung disease, in particular sarcoidosis and tuberculosis. The aim of this retrospective analysis was to assess the value of ¹⁸F-FDG-PET/CT in the identification of previously unknown malignant disease during routine investigation of granulomatous lung disease. MATERIALS AND METHODS From July 2008 to December 2013, a total of 122 patients with tuberculosis (76 male and 46 female patients; age range 19.6-88.6 years, mean 52.8±16.6 years) and 85 patients with sarcoidosis (46 male and 39 female patients; age range 17.8-76.5 years, mean 48.6±13.8 years) underwent ¹⁸F-FDG-PET/CT. Reports were generated in consensus by both a nuclear medicine physician and a radiologist. Possibly malignant findings underwent biopsies and/or follow-up. Quantitative parameters (maximum standardized uptake value) were pooled and compared from reference lesions in each group. RESULTS Malignant disease was suspected in 18 of 122 tuberculosis patients and in eight of 85 sarcoidosis patients. Malignancy was finally confirmed in six patients with tuberculosis and in two patients with sarcoidosis. In one single case a malignant lung tumour had been overlooked on PET/CT. Patients were also analysed according to their age. In the patient group older than 60 years, four malignancies were confirmed in 44 tuberculosis patients and in one in 20 sarcoidosis patients, whereas in patients aged between 30 and 60 years only three of 63 tuberculosis and one of 58 sarcoidosis cases showed malignancy compared with the 18 false-positive findings on a total patient basis. The most common site of malignant disease was the chest. Besides the intrathoracic findings, two cases of malignancy were detected outside the thorax. Quantitative evaluation did not reveal any statistically significant difference between the tuberculosis and sarcoidosis groups. CONCLUSION Differentiation between granulomatous inflammation and malignancy is challenging with ¹⁸F-FDG-PET/CT because of a large number of false-positive findings. The highest probability of detecting coexistent malignant disease was seen in patients older than 60 years who were suffering from tuberculosis. An important feature for identification of malignant disease, especially in the assessment of intrathoracic findings, has turned out to be the CT pattern; quantitative evaluation, in contrast, seems to have little clinical value.
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PET/CT Imaging in Cardiac Sarcoidosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-014-9305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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The prevalence of antinuclear antibodies in patients with sarcoidosis. Autoimmune Dis 2014; 2014:351852. [PMID: 25580285 PMCID: PMC4281448 DOI: 10.1155/2014/351852] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction. Sarcoidosis, which is a chronic inflammatory granulomatous disease, can mimic different rheumatologic diseases including connective tissue diseases. Antinuclear antibodies are the markers used for connective tissue diseases. Aim. To determine antinuclear antibody frequency and any possible correlation with clinical and laboratory data in sarcoidosis patients. Material and Method. Forty-two sarcoidosis patients, 45 rheumatoid arthritis patients, and 45 healthy volunteers who were followed up in rheumatology outpatient clinic were included in this study. Demographic, clinical, serological, and radiological data of all patients were recorded. Antinuclear antibodies were determined with indirect immunofluorescent method and 1/100 titration was accepted as positive. The cases that were ANA positive were evaluated with immunoblot method. Results. Average age of the 42 patients (10 males) with sarcoidosis was 45.2 (20–70 years), and average disease duration was 3.5 years. ANA positivity was detected in 12 (28.5%) patients with sarcoidosis (1/100 in 10 patients, 1/320 in two patients), in 19 of RA patients (42.2%), and in two of healthy volunteers in low titer (P < 0.001). In the subgroup analysis made by immunblot test, one patient had anticentromere antibody, one had anti-Ro antibody, one had anti-Scl-70 antibody, one had anti-dsDNA antibody, and eight patients were negative. The two patients who had anticentromere and anti-Scl-70 antibodies had also Sjögren's syndrome and scleroderma diagnosis, respectively. Discussion. The prevalence of ANA in patients with sarcoidosis was found to be significantly higher than healthy control group and lower than RA patients. This result shows that ANA may have an important role in the pathogenesis of sarcoidosis and also could be important in revealing the overlap syndromes of sarcoidosis-connective tissue diseases. Further studies with larger series are necessary in this subject.
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Abstract
The objective of this review is to highlight the clinical utility of FDG-PET/CT for evaluation of patients with chronic sarcoidosis. The emphasis was on the potential advantages and disadvantages of this technique in these patients based on which recommendations were made. The advantage of FDG-PET/CT technique is that it can visualize FDG accumulation in activated inflammatory cells and simultaneously provide PET and CT images. Of particular interest is the use of FDG-PET/CT for the staging and identification of occult sites and sites suitable for biopsy and for the assessment of inflammatory active sarcoidosis in patients with prolonged symptoms, especially when other markers of the disease are within normal values. FDG-PET/CT also provides a better visualization of extrathoracic sites of active sarcoidosis, such as in the bones, liver, spleen, and retroperitoneal lymph nodes. The use of FDG-PET/CT is of special interest in cardiac sarcoidosis because this potentially life-threatening disease is sometimes present in asymptomatic patients. FDG-PET/CT also has a role in the clinical management of patients with chronic persistent sarcoidosis, such as for planning treatment, monitoring response, and long-term follow-up. The limitations of FDG-PET/CT in patients with sarcoidosis are discussed in the context of a "sarcoidosis-lymphoma syndrome" and potentially excessive radiation exposure. Further prospective multicentre studies are needed to refine the clinical applications of FDG-PET/CT in patients with sarcoidosis and drive the field forward.
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Affiliation(s)
- Dragana Sobic-Saranovic
- Faculty of Medicine, University of Belgrade, Center for Nuclear Medicine, Clinical Center of Serbia, Belgrade, Serbia.
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Rubini G, Cappabianca S, Altini C, Notaristefano A, Fanelli M, Stabile Ianora AA, Niccoli Asabella A, Rotondo A. Current clinical use of 18FDG-PET/CT in patients with thoracic and systemic sarcoidosis. Radiol Med 2013; 119:64-74. [PMID: 24234183 DOI: 10.1007/s11547-013-0306-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/04/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE This study assessed the role of whole-body (18)fluorodeoxyglucose positron-emission tomography/computed tomography ((18)FDG PET/CT) in the restaging and follow-up of patients with sarcoidosis previously studied by multidetector computed tomography (MDCT). MATERIALS AND METHODS This retrospective study enrolled 21 patients to evaluate the sensitivity, specificity and accuracy of (18)FDG-PET/CT and MDCT. The results of the two techniques were compared with the Mc Nemar test. Cohen's K was used to compare concordance at the different lesion sites. RESULTS The sensitivity, specificity and accuracy of (18)FDG-PET/CT were 80, 66.67, and 76.19 %, respectively. The sensitivity, specificity and accuracy of MDCT were 93.33, 33.33, and 76.19 %, respectively. In 16 patients who underwent whole-body MDCT, the sensitivity, specificity and accuracy values were 91.67, 81.25, and 50 % (MDCT) and 100, 50, and 87.5 % ((18)FDG-PET/CT). CONCLUSIONS (18)FDG-PET/CT is useful in evaluating the extent of sarcoidosis and recognising lesions at different sites, including lymph nodes, lungs, liver, spleen and bone. It also improves the interpretation of the morphological lesions seen on MDCT and depicts a larger number of lesions. Therefore, (18)FDG-PET/CT could be used to complement other more traditional techniques for the restaging and follow-up in patients with sarcoidosis.
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Affiliation(s)
- Giuseppe Rubini
- U.O. Medicina Nucleare, Università degli Studi di Bari, Piazza G. Cesare 11, 70124, Bari, Italy,
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Tabuchi S, Uno T. Hydrocephalus with panventricular enlargement as the primary manifestation of neurosarcoidosis: a case report. J Med Case Rep 2013; 7:240. [PMID: 24124650 PMCID: PMC4015283 DOI: 10.1186/1752-1947-7-240] [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: 04/18/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Hydrocephalus is very uncommon in neurosarcoidosis. To date, there have been only five reported cases of hydrocephalus occurring as the first manifestation of neurosarcoidosis. Such a presentation in a previously healthy patient is challenging to diagnose. Case presentation A 31-year-old Japanese man who had no relevant past history other than sinusitis was admitted to our institution complaining of low-grade fever and mild headache. He was alert and neurologically intact. No respiratory symptoms were observed. Laboratory examination revealed mild elevation of erythrocyte sedimentation rate and serum CD4/CD8 ratio. Serum angiotensin-converting enzyme level was in the normal range. His cerebrospinal fluid showed mild pleocytosis and increased protein level. A chest X-ray revealed bihilar lymphadenopathy with normal lung parenchyma. Computed tomography of his head showed remarkable hydrocephalus with dilatation of all ventricles, particularly the fourth. Gadolinium-enhanced magnetic resonance imaging demonstrated leptomeningeal millet seed-like enhancement and multiple small enhancing lesions along the Virchow–Robin spaces. These findings strongly suggested a chronic inflammatory disease such as neurosarcoidosis. To treat the hydrocephalus, a ventriculoperitoneal shunt was inserted. The postoperative course was satisfactory. After surgery, nasal and skin biopsies were performed and pathological analysis revealed non-caseating granulomas consistent with sarcoidosis. The findings of gallium scintigraphy also supported the diagnosis of sarcoidosis. We obtained the definitive diagnosis of sarcoidosis 3 weeks after admission from the pathological findings by the nasal and skin biopsies, and corticosteroid therapy was started after that. Conclusion We present a rare case of neurosarcoidosis manifesting as acute hydrocephalus with dilatation of all ventricles, particularly the fourth. As hydrocephalus due to neurosarcoidosis has high morbidity and mortality, early diagnosis and proper treatment are particularly important.
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Affiliation(s)
- Sadaharu Tabuchi
- Department of Neurosurgery, Institute of Neurological Sciences, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago 683-8504, Japan.
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Affiliation(s)
- Mark D. Hoffman
- Department of Dermatology; Rush University Medical Center; Chicago; Illinois
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Tannen BL, Kolomeyer AM, Turbin RE, Frohman L, Langer PD, Oh C, Ghesani NV, Zuckier LS, Chu DS. Lacrimal gland uptake of (67)Ga-gallium citrate correlates with biopsy results in patients with suspected sarcoidosis. Ocul Immunol Inflamm 2013; 22:15-22. [PMID: 23730797 DOI: 10.3109/09273948.2013.791700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate whether lacrimal gland uptake on (67)Ga-gallium citrate scintigraphy correlates with histopathologic evidence of sarcoidosis. METHODS A retrospective, pilot study of 31 patients with suspected sarcoidosis who underwent gallium scintigraphy and lacrimal gland biopsy. Lacrimal gland gallium uptake was assessed by subjective visual scoring (SVS) and lacrimal uptake ratio (LUR). RESULTS Eleven (36%) patients had lacrimal gland biopsies containing noncaseating granulomas. A statistically significant correlation was found between lacrimal gland gallium uptake and biopsy positivity using SVS (p = 0.03) or LUR (p = 0.01). Using SVS, biopsy positivity rate increased from 0 to 50% in patients with mild to intense uptake. Using LUR, biopsy positivity rate increased linearly as the ratio increased from 13% (LUR < 4) to 100% (LUR > 8). CONCLUSIONS Lacrimal biopsy positivity rate significantly correlated with gallium uptake on scintigraphy. Both SVS and LUR methods appear to correlate with histologic results and may potentially aid in patient selection for biopsy.
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Affiliation(s)
- Bradford L Tannen
- Department of Ophthalmology, Mount Sinai School of Medicine , New York, New York , USA
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Sobic-Saranovic D, Grozdic I, Videnovic-Ivanov J, Vucinic-Mihailovic V, Artiko V, Saranovic D, Djuric-Stefanovic A, Masulovic D, Odalovic S, Ilic-Dudvarski A, Popevic S, Pavlovic S, Obradovic V. The utility of 18F-FDG PET/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis. J Nucl Med 2012; 53:1543-9. [PMID: 22879080 DOI: 10.2967/jnumed.112.104380] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED The purpose of this study was to assess the utility of (18)F-FDG PET/CT for detection of inflammation in granulomatous sites and management of patients with chronic sarcoidosis. The 3 specific aims were to assess differences between (18)F-FDG PET/CT and multidetector CT (MDCT) findings, to compare (18)F-FDG PET/CT results with serum levels of angiotensin-converting enzyme (ACE), and to determine whether (18)F-FDG PET/CT findings are associated with the decision to change therapy. METHODS We studied 90 sarcoidosis patients (mean age ± SD, 47 ± 12 y; 32 men and 58 women) with persistent symptoms who were referred for (18)F-FDG PET/CT evaluation to assess the extent of inflammation. They also underwent MDCT and measurement of serum ACE level. After the follow-up (12 ± 5 mo after (18)F-FDG PET/CT), the clinical status and changes in therapy were analyzed. RESULTS (18)F-FDG PET/CT detected inflammation in 74 patients (82%) (maximum standardized uptake value, 8.1 ± 3.9). MDCT was positive for sarcoidosis in 6 additional patients (80, 89%). The difference between the 2 methods was not significant (P = 0.238, McNemar test), and their agreement was fair (κ = 0.198). Although ACE levels were significantly higher in patients with positive than negative (18)F-FDG PET/CT results (P = 0.002, Mann-Whitney test), 38 patients (51%) with positive (18)F-FDG PET/CT results had normal ACE levels. The therapy was initiated or changed in 73 out of 90 patients (81%). Both univariate and multivariate logistic regression analyses indicated that positive (18)F-FDG PET/CT results were significantly (P < 0.001) associated with changes in therapy, with no contribution from age, sex, ACE level, CT results, or previous therapy. CONCLUSION Our results indicate that (18)F-FDG PET/CT is a useful adjunct to other diagnostic methods for detecting active inflammatory sites in chronic sarcoidosis patients with persistent symptoms, especially those with normal ACE levels. (18)F-FDG PET/CT proved advantageous for determining the spread of active disease throughout the body and influenced the decision to adjust the therapy.
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Rocha DS, Presotto C, Bringel DM, Bomm L, Balassiano E, Alves MDFGS. Sarcoidosis simulating syringomas. An Bras Dermatol 2012; 87:309-12. [PMID: 22570040 DOI: 10.1590/s0365-05962012000200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/15/2011] [Indexed: 11/21/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of unknown etiology. The skin is commonly affected. Cutaneous manifestations can mimic other diseases and autoimmune disorders. The dermatologist plays a critical role in elucidating the clinical diagnosis and assisting other specialists in the investigation of a systemic disease. We report a patient with typical cutaneous manifestation of sarcoidosis with pulmonary involvement.
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Affiliation(s)
- Diego Santos Rocha
- Dermatology Service, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Heath CR, David J, Taylor SC. Sarcoidosis: Are there differences in your skin of color patients? J Am Acad Dermatol 2012; 66:121.e1-14. [DOI: 10.1016/j.jaad.2010.06.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 06/03/2010] [Accepted: 06/06/2010] [Indexed: 01/19/2023]
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Pancreatic involvement detected with 18F-FDG PET/CT in disseminated sarcoidosis. ACTA ACUST UNITED AC 2011; 30:29-32. [DOI: 10.1016/j.remn.2010.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/25/2010] [Accepted: 04/27/2010] [Indexed: 11/23/2022]
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Low levels of NF-κB/p65 mark anergic CD4+ T cells and correlate with disease severity in sarcoidosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 18:223-34. [PMID: 21177920 DOI: 10.1128/cvi.00469-10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
T lymphocytes from patients with sarcoidosis respond weakly when stimulated with mitogen or antigen. However, the mechanisms responsible for this anergy are not fully understood. Here, we investigated the protein levels of nuclear transcription factor NF-κB (p50, p65, and p105), IκBα (inhibitor of NF-κB), T-cell receptor (TCR) CD3ζ-chain, tyrosine kinase p56(LCK), and nuclear factor of activated T cells c2 (NF-ATc2) in peripheral blood CD4(+) T cells from patients with sarcoidosis. Baseline expression of p65 in these lymphocytes was reduced in 50% of patients. The reduced levels of p65 in sarcoid CD4(+) T cells concurred with decreased levels of p50, p105, CD3ζ, p56(LCK), IκBα, and NF-ATc2. Polyclonal stimulation of NF-κB-deficient sarcoid T cells resulted in reduced expression of CD69 and CD154, decreased proliferation, and cytokine (i.e., interleukin 2 [IL-2] and gamma interferon [IFN-γ]) production. The clinical significance of these findings is suggested by the association between low p65 levels and the development of more severe and active sarcoidosis. Although correlative, our results support a model in which multiple intrinsic signaling defects contribute to peripheral T-cell anergy and the persistence of chronic inflammation in sarcoidosis.
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Rafi H, Latib R, Faik J, Kanouni L, Chami I, Boujida N, Jroundi L. Sarcoïdose mammaire chez une patiente traitée pour cancer du sein. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Reda E. Girgis
- Associate Professor, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Tremblay A, Stather DR, MacEachern P, Khalil M, Field SK. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest 2009; 136:340-346. [PMID: 19188547 DOI: 10.1378/chest.08-2768] [Citation(s) in RCA: 249] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes has been found to be more accurate than standard TBNA in the setting of malignancy. In patients with suspected sarcoidosis, the smaller ultrasound needle may yield inadequate material to make a histologic diagnosis of granulomatous inflammation. The aim of this study was to compare the diagnostic yield of EBUS-guided TBNA to TBNA performed with a standard 19-gauge needle in patients with mediastinal adenopathy and a clinical suspicion of sarcoidosis. METHODS A randomized controlled trial was performed in a university medical center, enrolling 50 patients (of 61 screened, 2 declined, and 9 did not meet entry criteria) with hilar and/or mediastinal adenopathy and a clinical suspicion of sarcoidosis. Twenty-four patients were randomized to undergo EBUS-guided TBNA and 26 to undergo TBNA using a standard 19-gauge needle. RESULTS The primary outcome measure of diagnostic yield was 53.8% vs 83.3% in favor of the EBUS-guided TBNA group, an absolute increase of 29.5% (p < 0.05; 95% confidence interval [CI], 8.6 to 55.4%). After blinded research pathology review, diagnostic yield was 73.1% vs 95.8%, in favor of the EBUS-guided TBNA group, an absolute increase of 22.7% (p = 0.05; 95% CI, 1.9 to 42.2%). Sensitivity and specificity were 60.9% and 100%, respectively, in the standard TBNA group, and 83.3% and 100%, respectively, in the EBUS-guided TBNA group (absolute increase in sensitivity, 22.5%; p = 0.085; 95% CI, 3.2 to 44.9%). CONCLUSIONS The diagnostic yield of EBUS-guided TBNA is superior to TBNA using a standard 19-gauge needle for sampling of mediastinal lymph nodes in patients with a clinical suspicion of sarcoidosis. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00373555.
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Affiliation(s)
- Alain Tremblay
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.
| | - David R Stather
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul MacEachern
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Moosa Khalil
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen K Field
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada
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Hansen SR, Hetta AK, Omdal R. Primary Sjögren's syndrome and sarcoidosis: coexistence more than by chance? Scand J Rheumatol 2008; 37:485-6. [PMID: 18830902 DOI: 10.1080/03009740802220075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Menias CO, Surabhi VR, Prasad SR, Wang HL, Narra VR, Chintapalli KN. Mimics of cholangiocarcinoma: spectrum of disease. Radiographics 2008; 28:1115-29. [PMID: 18635632 DOI: 10.1148/rg.284075148] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cholangiocarcinoma is the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15% of liver cancers. Diagnosis of cholangiocarcinoma is challenging and the prognosis is uniformly poor, with recurrence rates of 60%-90% after surgical resection. A wide spectrum of neoplastic and nonneoplastic conditions of the biliary tract may masquerade as cholangiocarcinoma, adding to the complexity of management in patients suspected to have cholangiocarcinoma. Mimics of cholangiocarcinoma constitute a heterogeneous group of entities that includes primary sclerosing cholangitis, recurrent pyogenic cholangitis, acquired immunodeficiency syndrome cholangiopathy, autoimmune pancreatitis, inflammatory pseudotumor, Mirizzi syndrome, xanthogranulomatous cholangitis, sarcoidosis, chemotherapy-induced sclerosis, hepatocellular carcinoma, metastases, melanoma, lymphoma, leukemia, and carcinoid tumors. These entities demonstrate characteristic histomorphology and variable clinicobiologic behaviors. The imaging findings of these disparate entities are protean and may be indistinguishable from those of cholangiocarcinoma. In most cases, a definitive diagnosis can be established only with histopathologic examination of a biopsy specimen.
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Affiliation(s)
- Christine O Menias
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
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Godoy MCB, Ost D, Geiger B, Novak C, Nonaka D, Vlahos I, Naidich DP. Utility of virtual bronchoscopy-guided transbronchial biopsy for the diagnosis of pulmonary sarcoidosis: report of two cases. Chest 2008; 134:630-636. [PMID: 18490401 DOI: 10.1378/chest.08-0052] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology that usually affects the lungs. Although flexible fiberoptic bronchoscopy with transbronchial lung biopsy (TBBx) has a high diagnostic yield in patients with pulmonary sarcoidosis, variously ranging from 40 to 90%, more invasive procedures often prove necessary. We report two cases of successful diagnosis of pulmonary sarcoidosis using a new technique that may increase the accuracy of TBBx. Previously described for diagnosis of peripheral lung cancer, this technique relies on real-time virtual bronchoscopic guidance to biopsy preselected peripheral areas of the lung preferentially affected by the disease using a pediatric bronchoscope. In each case, while procedures were performed under direct CT guidance allowing precise confirmation of the tip of the biopsy catheter, it is anticipated that this technique will be primarily used as a guide to bronchoscopic biopsies without the need for direct CT guidance, thus increasing routine utilization of multidetector low-dose high-resolution CT to improve histologic diagnosis.
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Affiliation(s)
- Myrna C B Godoy
- Department of Radiology, New York University School of Medicine, New, York, NY
| | - David Ost
- Department of Pulmonary Medicine, New York University School of Medicine, New, York, NY
| | | | | | - Daisuke Nonaka
- Department of Pathology, New York University Medical Center, New York University School of Medicine, New, York, NY
| | - Ioannis Vlahos
- Department of Radiology, New York University School of Medicine, New, York, NY
| | - David P Naidich
- Department of Radiology, New York University School of Medicine, New, York, NY.
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Abstract
A sarcoidose é doença granulomatosa não infecciosa de etiologia desconhecida, de cuja patogênese parecem participar os fatores genéticos, imunológicos, ambientais e infecciosos. Vários órgãos podem ser afetados, causando amplo espectro de manifestações clínicas. A pele é acometida em cerca de 20 a 35% dos casos, proporcionando ao dermatologista importante papel no diagnóstico da doença. Epidemiologia, imunologia e tratamento também são discutidos para prover melhor entendimento dessa enfermidade.
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Gur C, Lalazar G, Doviner V, Fridlender ZG, Molcho V, Abu-Much S, Shalit M, Elinav E. Late-onset sarcoidosis after liver transplantation for primary biliary cirrhosis. J Clin Gastroenterol 2007; 41:329-32. [PMID: 17426476 DOI: 10.1097/01.mcg.0000212653.51397.f6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Primary biliary cirrhosis (PBC) and systemic sarcoidosis are granulomatous diseases of unknown etiology whose hepatic manifestations may infrequently be imitative of one another. Described herein is the first reported case in the medical literature of systemic sarcoidosis developing after liver transplantation for PBC. The presented patient, who suffered from typical clinical, laboratory, and pathologic manifestations of PBC, developed decompensated liver cirrhosis within a course of 8 years, necessitating orthotopic liver transplantation. A year and a half after transplantation, the patient developed diffuse, biopsy-proven, dermatologic and pulmonary manifestations of systemic sarcoidosis, which promptly responded to corticosteroid treatment. In retrospect, the patient's longstanding liver disease was probably caused by an unrecognizable, isolated hepatic form of sarcoidosis or an overlap between PBC and sarcoidosis. This patient illustrates the complexity that may be rarely encountered in differentiating between PBC and hepatic sarcoidosis. Discussed are the clinical, laboratory, and pathologic overlaps between hepatic sarcoidosis and PBC, and clues that may aid in the diagnosis and differentiation between the 2 disorders. Hepatologists and liver transplantation specialists should be aware of the rare possibility of hepatic sarcoidosis imitating PBC, and exacerbating systemically after liver transplantation.
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Affiliation(s)
- Chamutal Gur
- Departments of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Ryu JH, Krowka MJ, Pellikka PA, Swanson KL, McGoon MD. Pulmonary hypertension in patients with interstitial lung diseases. Mayo Clin Proc 2007; 82:342-50. [PMID: 17352370 DOI: 10.4065/82.3.342] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pulmonary hypertension (PH) in patients with interstitial lung diseases (ILDs) is not well recognized and can occur in the absence of advanced pulmonary dysfunction or hypoxemia. To address this topic, we identified relevant studies in the English language by searching the MEDLINE database (1966 to November 2006) and by individually reviewing the references of identified articles. Connective tissue disease-related ILD, sarcoidosis, idiopathic pulmonary fibrosis, and pulmonary Langerhans cell histiocytosis are the ILDs most commonly associated with PH. Pulmonary hypertension is an underrecognized complication in patients with ILDs and can adversely affect symptoms, functional capacity, and survival. Pulmonary hypertension can arise in patients with ILDs through various mechanisms, Including pulmonary vasoconstriction and vascular remodeling, vascular destruction associated with progressive parenchymal fibrosis, vascular inflammation, perivascular fibrosis, and thrombotic angiopathy. Diagnosis of PH in these patients requires a high index of suspicion because the clinical presentation tends to be nonspecific, particularly in the presence of an underlying parenchymal lung disease. Doppler echocardiography is an essential tool in the evaluation of suspected PH and allows ready recognition of cardiac causes. Right heart catheterization is needed to confirm the presence of PH, assess its severity, and guide therapy. Management of PH in patients with ILDs is guided by identification of the underlying mechanism and the clinical context. An increasing number of available pharmacologic agents in the treatment of PH allow possible treatment of PH in some patients with ILDs. Whether specific treatment of PH in these patients favorably alters functional capacity or outcome needs to be determined.
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Affiliation(s)
- Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Knockaert DC, Vanderschueren S, Blockmans DE. Diagnostic strategy in systemic inflammatory diseases. Acta Clin Belg 2007; 62:26-35. [PMID: 17451143 DOI: 10.1179/acb.2007.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- D C Knockaert
- Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
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Abstract
Skin ulcerations may develop as a manifestation of a variety of different diseases or may result from some nondisease phenomena. Inflammatory ulcers refer specifically to those ulcerations in which inflammation is the primary pathologic process resulting in lesion formation; that is, inflammation is the cause rather than the consequence of the ulcer. This review will consider several types of inflammatory ulcers that the clinician may encounter in his or her practice.
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Affiliation(s)
- Mark D Hoffman
- Department of Dermatology, Rush Medical College, Chicago, IL 60612, USA.
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38
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Westney GE, Judson MA. Racial and ethnic disparities in sarcoidosis: from genetics to socioeconomics. Clin Chest Med 2006; 27:453-62, vi. [PMID: 16880055 DOI: 10.1016/j.ccm.2006.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown cause that occurs worldwide. The clinical expression of sarcoidosis varies by race. These racial differences may be the result of genetic and socioeconomic factors. Many of these genetic associations are race-specific in that they are found in either African Americans or whites but not both. Socioeconomic differences may also explain the racial disparities between African American and white patients with sarcoidosis. Finally, the phenotypic differences be-tween races may relate to an interaction between genetics and socioeconomic factors. The influences of genetics and socioeconomic status on the development and phenotypic expression of sarcoidosis will be better understood as the mechanisms of disease development are uncovered.
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Affiliation(s)
- Gloria E Westney
- Pulmonary and Critical Care Section, Department of Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA.
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39
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Poulin S, Brossard JH, Noël R, Isenring P. Hypercalcaemia in a patient with membraneous nephropathy. Nephrol Dial Transplant 2006; 21:1434-8. [PMID: 16495289 DOI: 10.1093/ndt/gfl046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sonya Poulin
- Nephrology Group, Hôpital L'Hôtel-Dieu de Québec Institution, Department of Medicine, Laval University, Québec (QC), G1R 2J6, Canada
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