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Della Torre A, Di Francesco P, Montanelli GA, Bolis M, Comelli A, Ferrarese M, Croci GA, Tobaldini E. An unusual case of pleural effusion. Intern Emerg Med 2023; 18:1127-1131. [PMID: 36890333 DOI: 10.1007/s11739-023-03236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/17/2023] [Indexed: 03/10/2023]
Abstract
CASE PRESENTATION A 63-year-old man presented with fever, thoracalgia, weight loss, diffuse lymphadenopathy, and a massive pleural effusion. Extensive laboratory and radiologic investigations for possible autoimmune, infectious, hematologic, and neoplastic conditions all resulted negative. A lymph node biopsy showed a granulomatous necrotizing lymphadenitis, suspicious for tuberculosis. Although mycobacterium tuberculosis (MT) was never isolated and tuberculin skin test resulted negative, diagnosis of extrapulmonary tuberculosis was made and anti-tubercular therapy was started. Despite the strict adherence to 5 months of treatment, he returned to the emergency ward complaining of fever, chest pain and pleural effusion; total-body CT and PET scans demonstrated a progression of new disseminated nodular consolidations. DIAGNOSTIC WORK-UP Microscopic and cultural search for MT and other micro-organisms resulted again negative on urine, stool, blood, pleural fluid, and spinal lesion biopsy. We therefore started considering alternative diagnosis for necrotizing granulomatosis, including multidrug-resistant tuberculosis, Wegener granulomatosis, Churg Strauss syndrome, necrobiotic nodules of rheumatoid arthritis, lymphomatoid granulomatosis and Necrotizing Sarcoid Granulomatosis (NSG). Having already rejected other autoimmune, hematological, and neoplastic disorders, NSG resulted the most consistent hypothesis. With an expert we thus re-examined histological specimens that were suggestive for an atypical presentation of sarcoidosis. Steroid therapy was initiated, achieving symptoms improvement. DISCUSSION Sarcoidosis is a rare condition that can be challenging to diagnose, due to its variability in clinical presentation, often mimicking alternative conditions like disseminated tuberculosis. A high degree of suspicion and an experienced lab in anatomical pathology are essential for final diagnosis.
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Affiliation(s)
- Alice Della Torre
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Pietro Di Francesco
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Gaia Annalisa Montanelli
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Matteo Bolis
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Agnese Comelli
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Maurizio Ferrarese
- Regional TB Reference Centre, Villa Marelli Institute and Laboratory/ASST GOM Niguarda, 20122, Milan, Italy
| | - Giorgio Alberto Croci
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy.
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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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El Jammal T, Pavic M, Gerfaud-Valentin M, Jamilloux Y, Sève P. Sarcoidosis and Cancer: A Complex Relationship. Front Med (Lausanne) 2020; 7:594118. [PMID: 33330555 PMCID: PMC7732692 DOI: 10.3389/fmed.2020.594118] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of non-caseating granulomas in various organs, mainly the lungs, and the lymphatic system. Since the individualization of sarcoidosis-lymphoma association by Brincker et al., the relationship between sarcoidosis or granulomatous syndromes and malignancies has been clarified through observational studies worldwide. Two recent meta-analyses showed an increased risk of neoplasia in sarcoidosis. The granulomatosis can also reveal malignancy, either solid or hematological, defining paraneoplastic sarcoidosis. Recent cancer immunotherapies, including immune checkpoint inhibitors (targeting PD-1, PD-L1, or CTLA-4) and BRAF or MEK inhibitors were also reported as possible inducers of sarcoidosis-like reactions. Sarcoidosis and neoplasia, especially lymphoma, can show overlapping presentations, thus making the diagnosis and treatment harder to deal with. There are currently no formal recommendations to guide the differential diagnosis workup between the evolution of lymphoma or a solid cancer and a granulomatous reaction associated with neoplasia. Thus, in atypical presentations (e.g., deeply impaired condition, compressive lymphadenopathy, atypical localization, unexplained worsening lymphadenopathy, or splenomegaly), and treatment-resistant disease, targeted biopsies on suspect localizations with histological examination could help the clinician to differentiate neoplasia from sarcoidosis. Pathological diagnosis could sometimes be challenging since very few tumor cells may be surrounded by massive granulomatous reaction. The sensitization of currently available diagnostic tools should improve the diagnostic accuracy, such as the use of more “cancer-specific” radioactive tracers coupled with Positron Emission Tomography scan.
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Affiliation(s)
- Thomas El Jammal
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France
| | - Michel Pavic
- Medicine Department, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Yvan Jamilloux
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,INSERM U1111, Center International de Recherche en Infectiologie/International Research Center in Infectiology (CIRI), University Claude-Bernard Lyon 1, Villeurbanne, France
| | - Pascal Sève
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,Pôle IMER, Hospices Civils de Lyon, Lyon, France.,HESPER EA 7425, Lyon University, University Claude-Bernard Lyon 1, Lyon, France
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Une rate hétérogène. Rev Med Interne 2017; 38:564-565. [DOI: 10.1016/j.revmed.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/14/2016] [Indexed: 11/17/2022]
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Atig A, Guiga A, Bouker A, Ghannouchi N, Bahri F. [Atypical sarcoidosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:113-114. [PMID: 28162797 DOI: 10.1016/j.pneumo.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/14/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Affiliation(s)
- A Atig
- Service de médecine interne, CHU Farhat Hached de Sousse, Sousse, Tunisie.
| | - A Guiga
- Service de médecine interne, CHU Farhat Hached de Sousse, Sousse, Tunisie
| | - A Bouker
- Service de médecine interne, CHU Farhat Hached de Sousse, Sousse, Tunisie
| | - N Ghannouchi
- Service de médecine interne, CHU Farhat Hached de Sousse, Sousse, Tunisie
| | - F Bahri
- Service de médecine interne, CHU Farhat Hached de Sousse, Sousse, Tunisie
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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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de Charry F, Sadoune K, Sebban C, Rey P, de Parisot A, Nicolas-Virelizier E, Belhabri A, Ghesquières H, Ninet J, Faurie P. [Association of lymphoma and granulomatosis: A case series]. Rev Med Interne 2015; 37:453-9. [PMID: 26611429 DOI: 10.1016/j.revmed.2015.10.344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/24/2015] [Accepted: 10/23/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The sarcoidosis-lymphoma syndrome is a recognised entity. However, the presence of granulomas in patients with a haematological disease should not lead too easily to a diagnosis of sarcoidosis. The presence of granulomatous lesions during the follow-up of these patients raises diagnostic and therapeutic issues. METHODS We included 25 patients followed by the department of haematology in a French hospital (Centre Léon-Bérard). These patients presented with granulomatous lesions. Patients with a history of sarcoidosis were excluded. We report the type of haematological disease, the time of onset of the granulomatous disease compared to that of lymphoma, associated symptoms, aetiology and outcome. Patients were divided into three groups according to the time of onset of the granulomatous lesions. RESULTS Granulomatous lesions appeared before the haematological disease in 4 cases, was concomitant in 8 cases and appeared later in 13 remaining cases. The two main subtypes of lymphoma encountered were: diffuse large cell lymphoma (36%) and Hodgkin's lymphoma (28%). Granulomatous lesions were related to the progression of the hematological disease in 11 cases, to sarcoidosis in 4 cases, to infection in 3 cases, to drug allergy in one case, to inflammatory bowel disease in one case, to granuloma annulare in one case and was isolated in 4 cases (no identified etiology). In the group where granulomas appeared after the haematological disease, mean SUV was 11 for the haematological disease versus 6.4 for granulomas. CONCLUSION Granulomatous diseases in lymphomas can be due to various aetiologies: infection, reaction to the haematological disease, or systemic sarcoidosis. It is an important challenge for clinicians, who can miss the diagnosis of lymphoma and or conclude to a treatment failure or a relapse. Computed tomography scan (CT-scan) or (18)F-deoxyglucose-positron emission tomography scan can help establish a diagnosis but do not replace biopsy.
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Affiliation(s)
- F de Charry
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France; Service de médecine interne, hôpital d'Instruction des Armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
| | - K Sadoune
- Service de médecine nucléaire, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - C Sebban
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - P Rey
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - A de Parisot
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | | | - A Belhabri
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - H Ghesquières
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - P Faurie
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
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El Bousaadani A, Eljahd L, Benbakh M, Mahtar M. Nasopharyngeal mass filling the choanae revealing sarcoidosis. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:309-10. [PMID: 26381676 DOI: 10.1016/j.anorl.2015.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A El Bousaadani
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20-Août-1953, CHU Ibn Rochd, 6, rue Lahssen, Elaarjoun, Casablanca, Morocco.
| | - L Eljahd
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20-Août-1953, CHU Ibn Rochd, 6, rue Lahssen, Elaarjoun, Casablanca, Morocco
| | - M Benbakh
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20-Août-1953, CHU Ibn Rochd, 6, rue Lahssen, Elaarjoun, Casablanca, Morocco
| | - M Mahtar
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20-Août-1953, CHU Ibn Rochd, 6, rue Lahssen, Elaarjoun, Casablanca, Morocco
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Marzouk S, Hriz H, Jallouli M, Cherif Y, Bahloul Z. [Association sarcoidosis and Horton disease: report of a case]. Pan Afr Med J 2015. [PMID: 26213599 PMCID: PMC4506795 DOI: 10.11604/pamj.2015.20.98.5946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
La sarcoïdose peut être associée à d'autres maladies inflammatoires. Elle est exceptionnellement associée à une maladie de Horton posant un problème nosologique sur le caractère fortuit ou non de cette association. Nous rapportons l'observation d'une patiente, âgée de 68 ans, chez qui le diagnostic de sarcoïdose avec atteinte rénale, hépatique, oculaire, articulaire et signes généraux a été retenu et ayant été traitée par corticothérapie avec une bonne évolution. 3 ans plus tard elle a présenté des céphalées fronto-temporales associées à une claudication massétérienne et un syndrome inflammatoire biologique. La biopsie de l'artère temporale a conclu à une artérite à cellules géantes. L’évolution a été favorable sous corticothérapie. L'association d'une maladie de Horton à une sarcoïdose suggère un lien éventuel entre ces deux affections.
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Affiliation(s)
- Sameh Marzouk
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Hela Hriz
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Moez Jallouli
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Yosra Cherif
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
| | - Zouhir Bahloul
- Service de Médecine Interne, CHU Hédi Chaker, Sfax, Tunisie
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de Gennes C, Leata C, Oliviero G, Régnard JF, Blivet S, Carpentier MC, Colby T, Bouillet L, Jeunemaitre X. Un trou peut en cacher un autre. Rev Med Interne 2014; 35:68-72. [DOI: 10.1016/j.revmed.2013.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 05/27/2013] [Indexed: 12/01/2022]
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Mosea H, Gotto J, Khan Z. Diagnostic and therapeutic challenges of hepatic sarcoidosis. BMJ Case Rep 2011; 2011:bcr.04.2011.4069. [PMID: 22689553 DOI: 10.1136/bcr.04.2011.4069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report three cases of hepatic sarcoidosis complicated by portal hypertension in Caucasian patients. The cases varied in their presentations from normal liver function to symptomatic cholestasis and established liver cirrhosis. In one particular case the authors discovered hepatic sarcoid after a diagnostic gastroscopy for upper gastrointestinal (GI) bleeding which showed changes of portal hypertension. In all of these cases the authors gave our patients a prolonged course of immunosuppressive treatment with over all good long-term results. The authors hope that our work will provide a modern approach into treating this disease.
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Affiliation(s)
- Haider Mosea
- Gastroenterology Department, Cheltenham General Hospital, Cheltenham, Gloucestershire, UK.
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Brillet PY, Nunes H, Soussan M, Brauner MW. [Pulmonary sarcoidosis imaging]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:94-100. [PMID: 21497723 DOI: 10.1016/j.pneumo.2010.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 06/20/2010] [Indexed: 05/30/2023]
Abstract
Sarcoidosis is a juvenile systemic granulomatosis. Its polymorphic clinical presentation depends on its different localisations, thoracic and extrathoracic. The role of imaging is very important for all localisations; but for mediastinopulmonary involvement, which is the most frequent (>90% of cases), it plays a major role in detecting the disease, diagnosing it, its prognosis, decision-making regarding treatment of it and in the monitoring of its development. Standard radiography, which sometimes detects the disease, forms the basis for its four-stage prognostic classification. CT scanning enables the study of mediastinal and hilar lymphadenopathy and the study of parenchyma, making it possible to identify micronodules of lymphatic distributions, alveolar opacities, septal lines, ground-glass hyperintensities, nodules surrounded by a ring of satellite micronodules, peribronchovascular thickening; all potentially reversible lesions. Elsewhere, it highlights irreversible fibrous lesions: hilar peripheral linear opacities; septal linear opacities; bronchial distortion, honeycomb destruction or even perihilar fibrotic masses. Less frequently we can visualise bronchiolar or cystic involvement. Benign in most cases, the sarcoidosis prognosis becomes bleaker in the event of hemoptysis, Aspergillus colonisation or before the onset of pulmonary hypertension.
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Affiliation(s)
- P-Y Brillet
- Service de radiologie, hôpital Avicenne, 125 route de Stalingrad, Bobigny cedex, France.
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Current World Literature. Curr Opin Rheumatol 2009; 21:85-92. [DOI: 10.1097/bor.0b013e32832355a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Armengol G, Bernet J, Lahaxe L, Lévesque H, Marie I. [Uncommon manifestation revealing sarcoidosis]. Rev Med Interne 2008; 30:53-7. [PMID: 18835653 DOI: 10.1016/j.revmed.2008.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/08/2008] [Accepted: 07/31/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Bilateral hilar lymphadenopathy, with or without lung parenchymal infiltrates, is the most common radiographic finding in patients with sarcoidosis. Atypical pulmonary findings have been uncommonly reported and include multiple large lung nodules, cavitation, lobar collapse, pleural effusions or pneumothorax. OBSERVATION We report a 21-year-old non caucasian patient who presented with pulmonary nodular infiltration and sinonasal involvement revealing sarcoidosis. Thoracic and sinus computed tomographic scan showed both multiple excavated large lung nodules and micronodules, hilar lymphadenopathy and sinus thickening. Laboratory studies disclosed elevated angiotensin converting enzyme serum level (120UI/L). Outcome was favorable after institution of corticosteroids (at an initial dose of prednisone of 1mg/kg/day); at eight-month-follow-up, the patient was asymptomatic, while receiving prednisone 22.5mg/day. CONCLUSION In patients exhibiting unusual pulmonary manifestations, diagnosis of sarcoidosis relies on compatible clinical signs, evidence of non-caseating granulomas, and exclusion of underlying conditions including infections, malignancy and other granulomatous diseases (Wegener disease, pneumoconiosis).
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Affiliation(s)
- G Armengol
- Département de médecine interne, CHU de Rouen-Boisguillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France
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