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Chergaoui I, Kherrab A, Ghazi M, Raissi A, Azami MA, Niamane R. Inflammatory Myalgia, A Rare Presentation of Hodgkin's Lymphoma: About a Case. Cureus 2023; 15:e47379. [PMID: 38021870 PMCID: PMC10657574 DOI: 10.7759/cureus.47379] [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] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Hodgkin's lymphoma (HL), also known as Hodgkin lymphoma or Hodgkin disease, is a type of malignancy that originates in B lymphocytes, which are a type of white blood cells involved in the immune system. It is characterized by the presence of abnormal Reed-Sternberg cells within the lymph nodes or other lymphoid tissues. Bone involvement of HL is exceptional, which can be localized or part of a disseminated disease. The case of our patient is a Hodgkin's lymphoma initially presenting with a complaint of myalgia. Magnetic resonance imaging and 8F-fluorodeoxyglucose positron emission tomography (FDG PET) played a crucial role in the diagnosis of this rare case.
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Affiliation(s)
- Ilyass Chergaoui
- Department of Rheumatology, Military Hospital Avicenne, Marrakech, MAR
| | - Anas Kherrab
- Department of Rheumatology, Military Hospital Avicenne, Marrakech, MAR
| | - Mirieme Ghazi
- Department of Rheumatology, Military Hospital Avicenne, Marrakech, MAR
| | - Abderrahim Raissi
- Department of Hematology, Military Hospital Avicenne, Marrakech, MAR
| | - Mohamed Amine Azami
- Department of Pathology, Caddi Ayyad University of Marrakech/Ibn Sina Military Hospital, Marrakech, MAR
| | - Redouane Niamane
- Department of Rheumatology, Military Hospital Avicenne, Marrakech, MAR
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Ahmed Ghassem M, El Maghraoui A, Djossou JH, Hamza T, Mounach A, Achemlal L. Bilateral swelling of the forearms revealing muscular sarcoidosis: a case-based review. Clin Rheumatol 2020; 39:3869-3873. [PMID: 32594282 DOI: 10.1007/s10067-020-05259-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
Muscular sarcoidosis is rarely symptomatic and mainly affects proximal muscles of the lower extremities. However, the distal localization in the upper extremities is rare. We used systematic approach to analyze all relevant literature review and we identified only three cases of muscular sarcoidosis of the upper extremities. We report the case of a 56-year-old woman who presented distal and bilateral swelling of the extensor surface of the forearms revealing muscular sarcoidosis. The laboratory exams associated elevated acute phase reactants with elevated serum angiotensin-converting enzyme levels and normal serum muscle enzymes. Ultrasound and MRI showed a bilateral and symmetrical muscle hypertrophy of the extensors of the fingers. Histological examination of muscle specimen and minor salivary gland biopsy revealed noncaseating epithelioid-cell granulomas. Therefore, the diagnosis of muscular sarcoidosis of the finger extensor muscles was made. Swelling of the forearms disappeared gradually under prednisolone 1 mg/kg/day. We used methotrexate as a steroid-sparing agent. Muscular MRI in sarcoidosis is not specific, but is to make a diagnosis of the lesion to optimize the biopsy which the cornerstone of the diagnosis ofsarcoidosis.
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Affiliation(s)
| | - Abdellah El Maghraoui
- Cabinet of Rheumatology, Av. Mohamed V, Street Bait Lahm, Buil B, n°6, Rabat, Morocco
| | | | - Toufik Hamza
- Rheumatology Department, Mohammed V University, Rabat, Morocco
| | - Aziza Mounach
- Rheumatology Department, Mohammed V University, Rabat, Morocco
| | - Lahsen Achemlal
- Rheumatology Department, Mohammed V University, Rabat, Morocco
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Abstract
A 43-year-old woman, with previous history of renal lithiasis, was admitted on an emergency for severe hypercalcemia fortuitously discovered in a context of rapidly progressive kidney failure. An F-FDG PET/CT performed to rule out underlying malignancy revealed an intense diffuse and isolated muscular FDG uptake with fascia infiltration on the CT finding. A muscular biopsy was performed and demonstrated a non-necrosing granuloma with multinucleated giant cells consistent with muscular sarcoidosis. A corticotherapy was started with a rapid normalization of serum calcium level. The follow-up F-FDG PET/CT 4 months later showed a complete response of the sarcoidosis myositis.
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Christensen A, Di Loreto C, Smitaman E, Paravar T, Jones KA, Guma M. Granulomatous fasciitis followed by morphea profunda: Is granulomatous fasciitis part of a spectrum of deep morphea? A case report and review of the literature. Clin Case Rep 2018; 6:1412-1417. [PMID: 30147873 PMCID: PMC6098999 DOI: 10.1002/ccr3.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022] Open
Abstract
Although eosinophilic fasciitis is known to be part of the deep morphea spectrum, this first report of the coexistence of granulomatous fasciitis and morphea profunda suggests that granulomatous fasciitis may also be a part of the spectrum of deep morphea.
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Affiliation(s)
- Angie Christensen
- Department of RheumatologySchool of MedicineUniversity of California, San DiegoLa JollaCAUSA
| | - Christina Di Loreto
- Department of PathologySchool of MedicineUniversity of California, San DiegoLa JollaCAUSA
| | - Edward Smitaman
- Department of RadiologySchool of MedicineUniversity of California, San DiegoLa JollaCAUSA
| | - Taraneh Paravar
- Department of DermatologySchool of MedicineUniversity of California, San DiegoLa JollaCAUSA
| | | | - Monica Guma
- Department of RheumatologySchool of MedicineUniversity of California, San DiegoLa JollaCAUSA
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Ferriby D, de Sèze J. Neurosarcoidosi. Neurologia 2016. [DOI: 10.1016/s1634-7072(16)78803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mageau A, Rigolet A, Benali K, Chauchard M, Ladjeroud S, Mahe I, Maisonobe T, Chauveheid MP, Papo T, Sacre K. Life-Threatening Hypercalcemia Revealing Diffuse and Isolated Acute Sarcoid-Like Myositis: A New Entity? (A Case-Series). Medicine (Baltimore) 2016; 95:e3089. [PMID: 26962842 PMCID: PMC4998923 DOI: 10.1097/md.0000000000003089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Up to 50% patients with sarcoidosis display extra-pulmonary disease. However, initial and isolated (ie, without lung disease) acute muscular involvement associated with pseudo-malignant hypercalcemia is very uncommon. We report on 3 cases of life-threatening hypercalcemia revealing florid and isolated acute sarcoid-like myositis.All patients complained of fatigue, progressive general muscle weakness, and weight loss. Laboratory tests showed a severe life-threatening hypercalcemia (>3.4 mmol/L). Hypercalcemia was associated with increased serum level of 1,25-(OH)2 vitamin D and complicated with acute renal failure. One patient displayed acute pancreatitis due to hypercalcemia.In all cases, PET-scan, performed for malignancy screening, incidentally revealed an intense, diffuse, and isolated muscular fluorodeoxyglucose (FDG) uptake consistent with diffuse non-necrotizing giant cells granulomatous myositis demonstrated by muscle biopsy. Of note, creatine phosphokinase blood level was normal in all cases. No patients displayed the usual thoracic features of sarcoidosis.All patients were treated with high dose steroids and achieved rapid, complete, and sustained remission. A review of English and French publications in Medline revealed 5 similar published cases.Steroid-sensitive acute sarcoid-like myositis causing high calcitriol levels and life-threatening hypercalcemia should be recognized as a separate entity.
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Affiliation(s)
- Arthur Mageau
- From the Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris (AM, MPC, TP, KS); Département de Médecine Interne, Centre de référence de pathologie neuromusculaire, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris (AR); Département de Médecine Nucléaire (KB); Département de Médecine Interne, Hôpital Saint Antoine, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris (MC); Département de Radiologie (SL), Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris; Département de Médecine Interne, Hôpital Louis Mourier, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, EA REMES 7334 Recherche Clinique ville-hôpital, Méthodologies et Société (IM); Département de Neuropathologie et Neurophysiologie, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris (TM); Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Université Paris Diderot, PRES Sorbonne Paris Cité (TP, KS); and INSERM U1149, Université Paris Diderot, Laboratoire d'excellence INFLAMEX, PRES Sorbonne Paris Cité (TP, KS), Paris, France
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Scalco RS, Brady S, Becker J, Gomes I, Holton JL, Staub HL. LETTER TO THE EDITOR Atypical Granulomatous Myositis and Pulmonary Sarcoidosis. Open Rheumatol J 2015; 9:57-9. [PMID: 26312107 PMCID: PMC4541420 DOI: 10.2174/1874312901409010057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/27/2015] [Accepted: 06/09/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Renata Siciliani Scalco
- Department of Neurology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil ; MRC Centre for Neuromuscular Diseases and Division of Neuropathology, Institute of Neurology, University College London, London, UK
| | - Stefen Brady
- MRC Centre for Neuromuscular Diseases and Division of Neuropathology, Institute of Neurology, University College London, London, UK
| | - Jefferson Becker
- Department of Neurology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Irenio Gomes
- Department of Neurology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Janice L Holton
- MRC Centre for Neuromuscular Diseases and Division of Neuropathology, Institute of Neurology, University College London, London, UK
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