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Luong S, Winston D. Sarcoid Involving the Heart and Frontal Bone With Minimal Pulmonary Involvement. Am J Forensic Med Pathol 2024; 45:e5-e7. [PMID: 37490577 DOI: 10.1097/paf.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Susanna Luong
- From the Burrell College of Osteopathic Medicine, Las Cruces, NM
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2
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Gallo RA, Zhang MG, Abou Khzam R, Tang VD, Dubovy SR, Rong AJ. Osteolytic sarcoidosis of the orbit without pulmonary involvement. Orbit 2023; 42:548-552. [PMID: 35312414 DOI: 10.1080/01676830.2022.2042826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/12/2022] [Indexed: 01/12/2023]
Abstract
A 69-year-old woman with a history of a left orbital mass presented to the emergency room with progressive breakthrough pain in her left orbit despite medical therapy. On examination, there was extraocular motility restriction with diplopia upon left supraduction. Computed tomography (CT) scan of the orbits revealed soft tissue thickening of the left medial and superior periorbita and left lacrimal fossa; bony erosion of the left frontal bone, left orbital roof, and left lamina papyracea; and bilateral mass-like enlargement of the extraocular muscles. An orbitotomy with incisional biopsy was performed, and histopathological examination revealed non-caseating granulomatous inflammation consistent with sarcoidosis. Chest imaging demonstrated no sequela of pulmonary sarcoidosis, and her serum angiotensin converting enzyme (ACE) level was within normal range. She was treated with high-dose oral steroids with resolution of her symptoms. Her pain returned at the conclusion of the steroid taper, and it was controlled with chronic subcutaneous methotrexate and adalimumab injections.
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Affiliation(s)
- Ryan A Gallo
- Department of Oculoplastic Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michelle G Zhang
- Department of Oculoplastic Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rayan Abou Khzam
- Department of Pathology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vincent D Tang
- Department of Pathology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Department of Pathology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew J Rong
- Department of Oculoplastic Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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Feng H, Ma J, Zhao Y, Zheng R, Wang W. Sarcoidosis with Severe Bone Involvement: A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:2990. [PMID: 37761357 PMCID: PMC10528272 DOI: 10.3390/diagnostics13182990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Sarcoidosis is a systemic granulomatous disease of the lungs that commonly involves intrathoracic lymph nodes. Here, we report the case of a 68-year-old woman who complained of shortness of breath and had suffered from the enlargement of intrathoracic lymph nodes for 12 years, swelling of the right middle finger for 7 years, and nasal obstruction for 2 years. The damage to the phalange was aggravated continuously and a malignant lesion could not be excluded, thus leading to amputation of the right middle finger. Pathological data indicated chronic inflammatory granulomatous disease and anti-acid staining was negative. Examination of the paranasal sinuses indicated destruction of the sinonasal bone and the swollen mucosa. Combined with the elevated ratio of CD4+/CD8+ T cells in bronchoalveolar lavage fluid and other results, the patient was finally diagnosed with sarcoidosis and received corticosteroid therapy. The shortness of breath and abnormality of the nose were significantly improved after treatment. Our case demonstrated the process of differential diagnosis for systemic granulomatous diseases, indicating the necessity of corticosteroid therapy for systematic sarcoidosis.
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Affiliation(s)
- Haoshen Feng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jiangwei Ma
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China
| | - Yabin Zhao
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China
| | - Rui Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wei Wang
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China
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4
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Jaber JF, Allan RW, Mastin S, Lowther G. Osseous Metastasis: An Unusual Sarcoidosis Masquerade. Mayo Clin Proc 2023; 98:1205-1206. [PMID: 37536805 DOI: 10.1016/j.mayocp.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Johnny F Jaber
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL.
| | - Robert W Allan
- Pathology and Laboratory Medicine Service, Malcom Randall VA Medical Center, Department of Veterans Affairs, Gainesville, FL
| | - Suzanne Mastin
- Department of Radiology, Malcom Randall VA Medical Center, Department of Veterans Affairs, Gainesville, FL
| | - Grant Lowther
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL
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5
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Samia AM, Fabara Pino S, Sun L. Sarcoidosis With Skeletal Involvement Masquerading as Metastatic Malignancy. Cureus 2023; 15:e44457. [PMID: 37791207 PMCID: PMC10544283 DOI: 10.7759/cureus.44457] [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: 08/19/2023] [Indexed: 10/05/2023] Open
Abstract
Sarcoidosis is a systemic disorder characterized by noncaseating granuloma formation, which can affect any organ in the body; however, skeletal involvement is relatively uncommon. This case report presents a rare case of sarcoidosis primarily affecting the skeletal system in a 39-year-old man with a history of neurosarcoidosis. The patient presented with symptoms of nausea, vomiting, fatigue, weight loss, and lower back and pelvic pain, which were initially suspicious for malignancy. Computed tomography scans revealed lytic bone lesions and lymphadenopathy. However, a biopsy of a left inguinal lymph node confirmed necrotizing granulomatous lymphadenitis, which was consistent with necrotizing sarcoid granulomatosis - a rare variant of sarcoidosis. The patient was treated with systemic corticosteroids, which led to clinical improvement. The prognosis of sarcoidosis is generally good, with spontaneous remission occurring in up to two-thirds of patients; however, some patients may develop chronic and/or progressive disease. In particular, patients with a history of neurosarcoidosis may be at an increased risk for chronic or recurrent disease. This case highlights the importance of considering sarcoidosis in the differential diagnosis of patients presenting with nonspecific symptoms and lymphadenopathy, even in the absence of pulmonary involvement.
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Affiliation(s)
| | - Stephanie Fabara Pino
- Internal Medicine, University of Central Florida, School of Medicine/North Florida Hospital, Gainesville, USA
| | - Liang Sun
- Internal Medicine, University of Central Florida, School of Medicine/North Florida Hospital, Gainesville, USA
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6
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Błasińska K, Jędrych ME, Opoka L, Tomkowski W, Szturmowicz M. Imaging Plays a Key Role in the Diagnosis and Control of the Treatment of Bone Sarcoidosis. Biomedicines 2023; 11:1866. [PMID: 37509505 PMCID: PMC10377349 DOI: 10.3390/biomedicines11071866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown origin. The most frequent localizations are thoracic lymph nodes and/or parenchymal lung disease, nevertheless any other organ may be involved. Musculoskeletal sarcoidosis, previously considered a rare manifestation of the disease, is presently recognized with increasing frequency, due to the development of modern imaging modalities. The classical X-ray sign of bone sarcoidosis is the image of lace in the phalanges of the hands. Most other locations present with atypical radiological images. Therefore, they may mimic metastatic neoplastic disease, especially when they are the first sign of sarcoidosis not previously recognized. On such occasions, none of the imaging methods will give the correct diagnosis, histopathological verification, monitoring of lesions or clinical data in a patient with confirmed sarcoidosis are indicated. The article summarizes the current status of knowledge concerning the recognition and therapy of bone sarcoidosis. In addition, an illustrative case of patient with bone and bone marrow sarcoidosis is presented.
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Affiliation(s)
- Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Małgorzata Ewa Jędrych
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Lucyna Opoka
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Monika Szturmowicz
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
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7
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Acro-osteolysis: imaging, differential diagnosis, and disposition review. Skeletal Radiol 2023; 52:9-22. [PMID: 35969258 DOI: 10.1007/s00256-022-04145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023]
Abstract
Acro-osteolysis is the osseous destruction of the hand or foot distal phalanges. The categories of the disease include terminal tuft, midshaft, or mixed types. Recognition of acro-osteolysis is straightforward on radiographs, but providing an accurate differential diagnosis and appropriately recommending advanced imaging or invasive tissue diagnosis can be more elusive. A radiologist's ability to provide advanced assessment can greatly aid clinicians in expedient diagnosis and management of the array of diseases presenting with acro-osteolysis.
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Fustà-Novell X, Mínguez-Blasco S, Creus-Vila L, Sallés-Lizarzaburu M. Sarcoid dactylitis as the initial manifestation of systemic sarcoidosis. REUMATOLOGIA CLINICA 2023; 19:57-58. [PMID: 36064884 DOI: 10.1016/j.reumae.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/13/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Xavier Fustà-Novell
- Servicio de Dermatología, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain.
| | - Sonia Mínguez-Blasco
- Servicio de Reumatología, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain
| | - Lidia Creus-Vila
- Servicio de Dermatología, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain
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9
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De Meester L, Cornelis L, Van Dorpe J, De Scheerder MA. Multiple bone lesions in a patient with fatigue: case report of bone sarcoidosis. Acta Clin Belg 2022; 77:541-545. [PMID: 33779516 DOI: 10.1080/17843286.2021.1903661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bone sarcoidosis is usually considered a rare manifestation of multisystemic sarcoidosis. With the growing use of more sensitive imaging techniques, such as 18F-FDG PET, the detection rate of bone involvement seems to be increasing. We describe the case of a woman presenting with fatigue and general malaise having multiple bone lesions on 18F-FDG PET. A broad range of differential diagnoses was considered, including malignancy, infections, metabolic diseases and primary bone tumours, which may have delayed the diagnosis. Diagnostic work-up eventually led to an anatomopathological diagnosis of bone sarcoidosis. Immunosuppressive therapy is often necessary since sarcoid bone lesions - even asymptomatic - generally appear in more extensive forms of the disease with other organ involvement.
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Affiliation(s)
- Liesbet De Meester
- Department of General Internal Medicine, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Leander Cornelis
- Department of General Internal Medicine, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
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10
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Jamilloux Y, El Jammal T, Bert A, Sève P. [Hydroxychloroquine for non-severe extra-pulmonary sarcoidosis]. Rev Med Interne 2022; 43:406-411. [PMID: 35660263 DOI: 10.1016/j.revmed.2022.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/11/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023]
Abstract
Sarcoidosis can develop into a chronic disease in about 30% of cases. When general treatment is indicated, corticosteroids are the first-line treatment. More than one third of patients treated with corticosteroids receive a steroid-sparing agent. Although methotrexate is the most commonly used sparing agent, synthetic antimalarials have been used for more than fifty years on the basis of small, randomised, therapeutic trials. Despite this low level of evidence, chloroquine or more often hydroxychloroquine are used in daily practice, particularly to treat skin, bone and joint sarcoidosis, as well as hypercalcemia and certain types of uveitis. This review summarises the state of knowledge on steroid-sparing therapy in sarcoidosis, particularly in its extra-pulmonary form. These data support the need for good quality therapeutic trials to validate the use of hydroxychloroquine in this specific indication.
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Affiliation(s)
- Y Jamilloux
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France; Lyon Immunopathology FEderation (LIFE), Université Claude Bernard-Lyon 1, Lyon, France.
| | - T El Jammal
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - A Bert
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France; Université Claude Bernard-Lyon 1, Research on Healthcare Performance (RESHAPE), Inserm U1290, Lyon, France
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Hasbani GE, Uthman I, Jawad AS. Musculoskeletal Manifestations of Sarcoidosis. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441211072475. [PMID: 35185345 PMCID: PMC8854226 DOI: 10.1177/11795441211072475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 01/12/2023]
Abstract
Since its initial description in the late 19th century, sarcoidosis has been extensively studied. Although the general mechanism of immune activation is known, many details especially in the context of disease associations are still missing. One of such associations is the musculoskeletal complications that are widely variable in terms of presentation and response to treatment. Sarcoidosis can involve the joints leading to acute and, less commonly chronic, arthritis. While acute arthritis is mostly self-resolving in nature, chronic arthritis may lead to deformity and destruction of the joint. Sarcoidosis can also involve the muscles, leading to different pathologies primarily categorized according to the clinical presentation, despite the efforts to find a new classification based on imaging, histological, and clinical findings. The bones can be directly and indirectly affected. Different types of bone lesions have been described, although around half of these patients remain asymptomatic. Osteoporosis, increased risk of fractures, hypercalcemia, and hypercalciuria are examples of the indirect effect of sarcoidosis on the bones, possibly contributed to elevated levels of calcitriol. Nevertheless, sarcoidosis can be associated with small-vessel, medium-vessel, and large vessel vasculitis, although it is frequently difficult to differentiate between the co-existence of a pure vasculitis and sarcoidosis and sarcoid vasculitis.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Sm Jawad
- Department of Rheumatology, The Royal London Hospital, London, UK
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12
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Multifocal Mycobacterium kansasii osteomyelitis in a patient on ruxolitinib. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2021.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Bone Tumors. Radiol Clin North Am 2022; 60:239-252. [DOI: 10.1016/j.rcl.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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O'Brien D, Aziz T, Kane D, Mullan RH. Deep tissue Koebner phenomenon in osseous sarcoidosis. Rheumatology (Oxford) 2021; 60:e384-e386. [PMID: 33961024 DOI: 10.1093/rheumatology/keab420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Diarmuid O'Brien
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Tahir Aziz
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Ronan H Mullan
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
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Cadiou S, Coiffier G, Jouneau S, Jego P, Perdriger A, Belhomme N, Guillin R, Guggenbuhl P. Sacroiliac joint in sarcoidosis on computed tomography: a monocentric retrospective study (SISTER). Rheumatol Int 2021; 42:431-440. [PMID: 34636939 DOI: 10.1007/s00296-021-05021-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
Sacroiliitis and spondyloarthritis (SpA) have been associated to sarcoidosis. Sarcoidosis bone involvement of the sacral or iliac bones has been reported to mimic SpA. We aimed to evaluate the prevalence of structural sacroiliitis and structural changes of the sacroiliac joints (SIJ) in patients with sarcoidosis by abdominal-pelvic computed tomography (AP-CT). In this monocentric retrospective study, three blinded readers evaluated AP-CT that had already been performed on patients with sarcoidosis and classified them as normal, degenerative, or inflammatory. A consensus was reached for the divergent cases. Erosion, ankylosis, and sclerosis, classically associated with sacroiliitis, were noted. SpA was defined according to the ASAS 2009 classification criteria. We identified 217 patients with proven sarcoidosis who underwent AP-CT. Only three patients had sacroiliitis by CT and four had SpA, representing 1.38% and 1.85% of the patients, respectively. Degenerative SIJs represented 28.1% of patients and were significantly associated with age, at least one pregnancy, rural lifestyle, ankylosis, diffuse idiopathic skeletal hyperostosis, sclerosis, and the presence of osteophytes. Four patients had axial bone sarcoidosis. Sacroiliitis, SpA, and degenerative changes of the SIJ have been highlighted by AP-CT in patients with sarcoidosis. Osteoarthritis of the SIJ in sarcoidosis was associated with age, pregnancy, and rural lifestyle. Further studies are needed to assess the link between SpA and sarcoidosis.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35000, Rennes, France.
| | | | - Stéphane Jouneau
- Department of Respiratory Medicine, Rennes University Hospital, Rennes, France.,University of Rennes 1, Rennes, France.,INSERM-IRSET UMR1085, Rennes, France
| | - Patrick Jego
- Internal Medicine Department, Rennes University Hospital, University of Rennes 1, 35000, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35000, Rennes, France
| | - Nicolas Belhomme
- Internal Medicine Department, Rennes University Hospital, 35000, Rennes, France
| | - Raphaël Guillin
- Department of Medical Imaging, Rennes University Hospital, 35000, Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35000, Rennes, France.,INSERM, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1241, Univ Rennes, 35000, Rennes, France
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How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis. Adv Ther 2021; 38:4605-4627. [PMID: 34296400 PMCID: PMC8408061 DOI: 10.1007/s12325-021-01832-5] [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: 03/18/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022]
Abstract
Extrapulmonary sarcoidosis occurs in 30–50% of cases of sarcoidosis, most often in association with pulmonary involvement, and virtually any organ can be involved. Its incidence depends according to the organs considered, clinical phenotype, and history of sarcoidosis, but also on epidemiological factors like age, sex, geographic ancestry, and socio-professional factors. The presentation, symptomatology, organ dysfunction, severity, and lethal risk vary from and to patient even at the level of the same organ. The presentation may be specific or not, and its occurrence is at variable times in the history of sarcoidosis from initial to delayed. There are schematically two types of presentation, one when pulmonary sarcoidosis is first discovered, the problem is then to detect extrapulmonary localizations and to assess their link with sarcoidosis, while the other presentation is when extrapulmonary manifestations are indicative of the disease with the need to promptly make the diagnosis of sarcoidosis. To improve diagnosis accuracy, extrapulmonary manifestations need to be known and a medical strategy is warranted to avoid both under- and over-diagnosis. An accurate estimation of impairment and risk linked to extrapulmonary sarcoidosis is essential to offer the best treatment. Most frequent extrapulmonary localizations are skin lesions, arthritis, uveitis, peripheral lymphadenopathy, and hepatic involvement. Potentially severe involvement may stem from the heart, nervous system, kidney, eye and larynx. There is a lack of randomized trials to support recommendations which are often derived from what is known for lung sarcoidosis and from the natural history of the disease at the level of the respective organ. The treatment needs to be holistic and personalized, taking into account not only extrapulmonary localizations but also lung involvement, parasarcoidosis syndrome if any, symptoms, quality of life, medical history, drugs contra-indications, and potential adverse events and patient preferences. The treatment is based on the use of anti-sarcoidosis drugs, on treatments related to organ dysfunction and supportive treatments. Multidisciplinary discussions and referral to sarcoidosis centers of excellence may be helpful for difficult diagnosis and treatment decisions.
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Herrán de la Gala D, Sáenz Aldea M, Azcona Sáenz J. [Skeletal sarcoidosis as an atypical presentation of the disease]. Semergen 2021; 47:e62-e64. [PMID: 34404585 DOI: 10.1016/j.semerg.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Affiliation(s)
- D Herrán de la Gala
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - M Sáenz Aldea
- Médico Interno Residente en Medicina Familiar y Comunitaria, Centro de Salud Dávila, Santander, Cantabria, España
| | - J Azcona Sáenz
- Servicio de Radiodiagnóstico, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, España
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18
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Nel H, Davis B, Adler B, Gabbay E. Case report of osteolytic lesions in a patient with multisystem granulomatous disease. BMJ Case Rep 2021; 14:14/6/e242685. [PMID: 34108156 DOI: 10.1136/bcr-2021-242685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a case of a 70-year-old Caucasian woman with multisystem granulomatous disease involving her lungs, bones and lymph nodes. The patient initially presented with cervical lymphadenopathy and subsequently developed progressive breathlessness. Imaging revealed extensive mediastinal, hilar and intra-abdominal lymphadenopathy as well as bilateral pulmonary parenchymal infiltrates. Lymph node and lung biopsy confirmed non-necrotising granulomatous inflammation while a BAL showed scanty growth of Cryptococcus neoformans and moderate growth of Staphylococcus aureus The patient received intravenous ceftriaxone and had a good response to treatment. She also completed 3 months of oral fluconazole. Although a diagnosis of sarcoidosis was considered most likely, the patient was not initially started on systemic corticosteroids due to concern around possible infection and initial response to antimicrobials. However, her exercise tolerance gradually deteriorated. A craniofacial CT revealed multiple lytic lesions involving the skull and visualised cervical spine. Biopsy of a clivus lesion revealed non-necrotising granulomatous inflammation while fungal cultures and histopathological stains were negative. The patient was diagnosed with widespread sarcoidosis and she was initiated on prednisolone and methotrexate which led to marked clinical and radiological improvement.
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Affiliation(s)
- Henco Nel
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Brad Davis
- SKG Radiology, St John of God Subiaco, Perth, Western Australia, Australia
| | - Brendan Adler
- Envision Medical Imaging, Perth, Western Australia, Australia
| | - Eli Gabbay
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
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Charifi Y, Dkhissi Y, Haloua M, Alaoui Lamrani Y, Berrady G, Boubbou M, Amarti A, Maaroufi M, Alami B. Pelvic and Lumbar Pain Revealing Bone Sarcoidosis: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211014788. [PMID: 34017208 PMCID: PMC8114277 DOI: 10.1177/11795476211014788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/13/2021] [Indexed: 11/22/2022]
Abstract
A 54-years-old woman suffered from a bilateral pelvic and lumbar pain. She had a systemic investigation shows a diffuse bone lesions. A biopsy of iliac bone was done and revealed sarcoidosis. Bony manifestations of sarcoidosis are rare and challenging to diagnose. Our report shows that MRI with diffusion weighted sequences is a simple and non invasive technique to evaluate bone infiltration. It helps to distinguish inflammatory disease from metastatic lesions and to guide the osseous biopsy. Moreover, fluorodeoxyglucose PET scan, are useful in establishing the extent of damage and measuring disease activity.
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Affiliation(s)
- Yahya Charifi
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Younes Dkhissi
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Meryem Haloua
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Youssef Alaoui Lamrani
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Ghizlane Berrady
- Internal Medicine Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Meryem Boubbou
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Afaf Amarti
- Anatomopathology Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mustapha Maaroufi
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Badreeddine Alami
- Radiology and Imaging Department, Centre Hospitalier Universitaire Hassan II, University Sidi Mohamed Ben Abdellah, Fez, Morocco
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20
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Chen X, Wang J, Han WL, Zhao K, Chen Z, Zhou JY, Shen YH. Sarcoidosis mimicking metastases in an echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase positive non-small-lung cancer patient: A case report. World J Clin Cases 2021; 9:3140-3146. [PMID: 33969101 PMCID: PMC8080747 DOI: 10.12998/wjcc.v9.i13.3140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/07/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rearrangements of the anaplastic lymphoma kinase (ALK) gene (ALK-positive) represent an oncogenic driver in approximately 3%-5% of non-small-lung cancer (NSCLC) patients. Sarcoidosis is a multisystem disease, and its reported incidence in Asia is 1 or less per 100000 people per year. The co-occurrence of sarcoidosis and ALK-positive NSCLC is rare, and ALK-positive lung cancer is likely to spread quickly. Therefore, the co-occurrence of sarcoidosis is more easily misdiagnosed as metastatic lung cancer by radiological examination.
CASE SUMMARY A 50-year-old man had a nodule in the left superior lobe, many small nodules in left superior and right lungs, and enlarged bilateral hilar, mediastinal, and right supraclavicular lymph nodes. Computed tomography-guided pulmonary biopsy of the nodule in the left superior lobe revealed echinoderm microtubule-associated protein-like 4 gene-ALK positive NSCLC with concomitant noncaseating granuloma. This patient was treated with crizotinib. Thirty days later, a chest computed tomography scan revealed a dramatic decrease in the size of the left superior lobe nodule; however, the lesions in the right lung progressed. The right supraclavicular lymph nodes showed granulomas, and no tumor cells were identified in the specimens. The angiotensin-converting enzyme level was high. After 1 wk of methylprednisolone treatment, a significant response of all lesions was revealed. Following radical resection of the lung cancer, noncaseating granulomas were observed in both lung tissues and lymph nodes, which resulted in a diagnosis of echinoderm microtubule-associated protein-like 4-ALK positive NSCLC accompanied with sarcoidosis.
CONCLUSION Our experience illustrates that pathological evidence is needed to confirm metastatic disease, especially when some suspected metastatic lesions are negative for malignancy.
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Affiliation(s)
- Xi Chen
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jie Wang
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wei-Li Han
- Department of Lung Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Kui Zhao
- Positron Emission Tomography Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Zhen Chen
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Ying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yi-Hong Shen
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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Sève P, Pacheco Y, Durupt F, Jamilloux Y, Gerfaud-Valentin M, Isaac S, Boussel L, Calender A, Androdias G, Valeyre D, El Jammal T. Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis. Cells 2021; 10:cells10040766. [PMID: 33807303 PMCID: PMC8066110 DOI: 10.3390/cells10040766] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022] Open
Abstract
Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25-50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren's syndrome, lupus pernio, Heerfordt's syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, 69007 Lyon, France
- Correspondence:
| | - Yves Pacheco
- Faculty of Medicine, University Claude Bernard Lyon 1, F-69007 Lyon, France;
| | - François Durupt
- Department of Dermatology, Lyon University Hospital, 69004 Lyon, France;
| | - Yvan Jamilloux
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Sylvie Isaac
- Department of Pathology, Lyon University Hospital, 69310 Pierre Bénite, France;
| | - Loïc Boussel
- Department of Radiology, Lyon University Hospital, 69004 Lyon, France
| | - Alain Calender
- Department of Genetics, Lyon University Hospital, 69500 Bron, France;
| | - 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;
| | - Dominique Valeyre
- Department of Pneumology, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne et Université Paris 13, Sorbonne Paris Cité, 93008 Bobigny, France;
| | - Thomas El Jammal
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
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22
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Patil S, Hilliard CA, Arakane M, Koppisetti Jenigiri S, Field EH, Singh N. Musculoskeletal sarcoidosis: A single center experience over 15 years. Int J Rheum Dis 2021; 24:533-541. [PMID: 33559378 DOI: 10.1111/1756-185x.14068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Musculoskeletal (MSK) sarcoidosis presents with a variety of clinical phenotypes. Four subtypes of MSK sarcoidosis have been identified to date: Lofgren syndrome, chronic sarcoid arthritis, osseous sarcoidosis, sarcoid myopathy. Each subtype has been reported with varying incidence mainly due to lack of universal classification criteria. METHODS We performed a retrospective chart review of patients with MSK sarcoidosis at a single academic center between January 2000 and December 2014. Descriptive statistics were used to describe the proportion of patients with sarcoidosis who had the 4 MSK syndromes of interest, demographic characteristics and therapeutic agents used. RESULTS A cohort of 58 patients with MSK manifestations were identified among 1016 patients with sarcoidosis. Frequency of subtypes include: Lofgren syndrome 46.6%, osseous sarcoidosis 25.9%, chronic sarcoid arthritis 24.1% and sarcoid myopathy 6.9%. The cohort was predominantly female (43/58 patients, 74%) and Caucasian (48/58 patients, 82.8%). Mean age was 47.2 years. One patient had overlap of osseous sarcoidosis and chronic sarcoid arthritis, another patient initially had Lofgren syndrome and later developed chronic sarcoid arthritis. Sarcoid myopathy patients presented with myalgia more often than muscle weakness. CONCLUSION We identified a large cohort of MSK sarcoidosis and determined the prevalence of all 4 subtypes. In patients who do develop MSK manifestations of sarcoidosis, they are commonly a part of the initial presentation of sarcoidosis. There is an unmet need to establish standardized classification criteria for the 4 MSK sarcoidosis syndromes.
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Affiliation(s)
- Sanjeev Patil
- Rheumatology, The University of Vermont Medical Center, Burlington, VT, USA
| | - Carolyn A Hilliard
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Sreedevi Koppisetti Jenigiri
- Division of Nephrology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Elizabeth H Field
- Division of Immunology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Namrata Singh
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, USA
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23
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Cattelan J. Osseous Sarcoidosis of the Hand. Mayo Clin Proc 2021; 96:498-499. [PMID: 33549268 DOI: 10.1016/j.mayocp.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Jessy Cattelan
- Department of Internal Medicine, Hopitaux Universitaires de Strasbourg, Strasbourg, Bas-Rhin, France.
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24
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Hosni IU, Karbhari B, Orr R, Opie N. Extensive bony sarcoidosis of the head and neck region: a rare presentation. BMJ Case Rep 2021; 14:14/1/e237105. [PMID: 33462005 PMCID: PMC7813348 DOI: 10.1136/bcr-2020-237105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We present a rare case of sarcoidosis with extensive bony destruction of the maxillofacial and skull base bones. A 65-year-old woman was referred with an asymptomatic, non-healing dental socket. Examination revealed an oroantral fistula that was biopsied and repaired under general anaesthesia. Investigations included plain and cross-sectional imaging. Serological tests, in particular ACE, were normal. Histology showed benign florid granulomatous inflammation. At 6 months, the patient remained asymptomatic. She was re-referred 3 years later with further bony destruction of her maxilla and mandible. Repeat imaging showed intrathoracic lymphadenopathy and skull base involvement. Repeat biopsy confirmed granulomatous inflammation. Given the pulmonary, histological and radiological findings, a sarcoidosis diagnosis was made. Following multidisciplinary team meetings, the patient was treated with methotrexate and arrangements made for close monitoring. This case highlights the need for a consensus in identifying, treating and developing a follow-up protocol in such patients.
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Affiliation(s)
- Iman Usama Hosni
- Oral and Maxillofacial Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - Bhavesh Karbhari
- Oral and Maxillofacial Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, Derbyshire, UK
| | - Robert Orr
- Oral and Maxillofacial Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - Neil Opie
- Oral and Maxillofacial Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, Derbyshire, UK
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25
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Razanamahery J, Caubet M, Gassian N, Echalier C, Soumagne T. Concurrent diagnosis of oropharynx cancer and bone sarcoidosis mimicking metastasis. Cancer Radiother 2020; 25:51-54. [PMID: 33376045 DOI: 10.1016/j.canrad.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 10/22/2022]
Abstract
Bone location is uncommon in both sarcoidosis and in neck cancer (HNC). Diagnosis of a bone lesion is therefore challenging to distinguish its nature in a patient suffering from both diseases. We report the case of a 69-years-old woman referred for P16 positive HPV-HNC. Magnetic Resonance Imaging (MRI) showed T2 hypo-signal on iliac crest and spine. 18FDG-PET demonstrated radiotracer uptake on these locations suggesting bone metastasis. However, bone biopsy showed epithelioid granuloma without malignant cells compatible with sarcoidosis location. The diagnosis of both localized advanced HPV-HNC and systemic sarcoidosis (bone, central nervous system) were retained. The patient received corticosteroid regimen at 0.5mg/kg/day and Methotrexate for sarcoidosis and radiation and chemotherapy with platins for carcinoma. As granulomatous bone marrow infiltration may have an uptake on 18FDG-PET, bone sarcoidosis can mimic metastatic disease. In addition, MRI often fails to distinguish sarcoidosis lesions from metastatic lesion in bones. As no reliable imaging test can decipher both diseases, the description of our case reinforces the necessity to perform bone biopsy in a patient suffering from both conditions to expertise the nature of bone lesions.
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Affiliation(s)
- J Razanamahery
- Service de médecine interne, centre hospitalier universitaire de Besançon, Besançon, France.
| | - M Caubet
- Institut de cancérologie de Bourgogne, Auxerre, France
| | - N Gassian
- Service d'oncologie médicale, centre hospitalier universitaire de Besançon, Besançon, France
| | - C Echalier
- Service de chirurgie orthopédique, centre hospitalier universitaire de Besançon, Besançon, France
| | - T Soumagne
- Service de pneumologie, centre hospitalier universitaire de Besançon, Besançon, France
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26
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Shumar J, Church T, Holtzclaw A, Zeman J. A rare case of osseous sarcoidosis presenting as lytic lesions 20 years after initial diagnosis. BMJ Case Rep 2020; 13:13/12/e239319. [PMID: 33371001 PMCID: PMC7757445 DOI: 10.1136/bcr-2020-239319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- John Shumar
- Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tyler Church
- Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Arthur Holtzclaw
- Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Joseph Zeman
- Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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27
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Abstract
Sarcoidosis is a systemic disease with a number of extrapulmonary manifestations, rarely limited to a single system. The objective of this review is to provide a overview of the systemic features of sarcoidosis and their surveillance. Sarcoidosis is disease that can affect any organ system, resulting in a number of complications that can cause significant morbidity and mortality, including ophthalmological and cardiac complications. A number of investigations play a role in identifying manifestations of sarcoidosis. Respiratory physicians have an important role to play in identifying complications and monitoring patients with sarcoidosis, as they may be the first to encounter them. Sarcoidosis can involve any organ system, with several complications, particularly ophthalmological and cardiac disease, that are important to recognise in clinical practice and monitor, no matter one's area of expertisehttps://bit.ly/36oLXxm
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Affiliation(s)
- Katrin Mannes
- Dept of Respiratory Medicine, Prince of Wales' Hospital, Sydney, Australia.,Prince of Wales' Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Paul S Thomas
- Dept of Respiratory Medicine, Prince of Wales' Hospital, Sydney, Australia.,Prince of Wales' Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Mechanisms of Disease and Translational Research, Faculty of Medicine, University of New South Wales, Sydney, Australia
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28
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Escoda T, Benyamine A, Belenotti P, Masson E, Chemouni D, Vaccaro J, Gabriel S, Swiader L, Weiller P, Rossi P, Granel B. Atteinte osseuse axiale de la sarcoïdose. Rev Med Interne 2020; 41:846-851. [DOI: 10.1016/j.revmed.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
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29
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Hémar V, Lazaro E, Viallard J, Deltombe T, Martin‐Lecamp G, Machelart I, Greib C, Rivière E. Sarcoid Dactylitis. Arthritis Rheumatol 2020; 72:1038. [DOI: 10.1002/art.41212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Estibaliz Lazaro
- University Hospital Centre of Bordeaux and University of Bordeaux Bordeaux France
| | | | | | | | | | | | - Etienne Rivière
- University Hospital Centre of Bordeaux and University of Bordeaux Bordeaux France
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30
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Abstract
Sarcoidosis is a systemic multisystem inflammatory disease of unknown etiology. The disease is characterized by formation of non-caseating granulomas. The most common presentation is bilateral hilar lymphadenopathy and lung infiltration, but the disease is very heterogeneous, with an unpredictable clinical course. Musculoskeletal manifestations are common. Bone involvement is less frequent, and usually occurs in patients with chronic multisystem course of the disease. They are most commonly found in the phalanges of hands and feet, and are usually bilateral. The skull, long bones, ribs, pelvis, and axial skeleton may also be affected. Osseous involvement may be asymptomatic but in some cases can cause a severe disability. Imaging techniques are important for diagnosis. Radiological investigations revealed sclerotic or destructive lesions (involving also joints), cystic and punched out lesions and cortical abnormalities. Biopsy is required for differential diagnosis with respect to malignancy. Treatment is a part of systemic therapy and is not needed in all cases. Glucocorticoids and TNF-α antagonists are used for management.
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31
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Robles LA, Matilla AF, Covarrubias MP. Sarcoidosis of the Skull: A Systematic Review. World Neurosurg 2020; 139:387-394. [PMID: 32339731 DOI: 10.1016/j.wneu.2020.04.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lesions of the skull make up a small but important part of neurosurgical practice. Several systemic disorders may involve the cranial vault including neoplastic and non-neoplastic conditions. Sarcoidosis of the skull is a little-known cause of calvarial involvement that has been rarely reported in the literature. The available information about skull sarcoidosis (SS) is sparse and is not well described; for this reason, we consider that a detailed description of this uncommon condition is necessary. METHODS An illustrative case of SS is presented; in addition, a PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with SS. Different information was analyzed in these cases to describe the characteristics of this condition. Also, different sources of literature were analyzed to complete the description of this clinical entity. RESULTS The search yielded 22 cases of patients with SS showing a variety of clinical manifestations. All studies were case reports. Most patients diagnosed with SS had no previous history of systemic sarcoidosis. Different characteristics of SS are analyzed and described in this paper. CONCLUSIONS The information collected from this review shows that SS is a rare condition that frequently is observed in patients without previous diagnosis of sarcoidosis. SS may manifest in different ways, and even may be found incidentally in some patients. The diagnosis of SS should be considered when multiple lytic skull lesions are observed, especially in cases of patients without a previous history of malignancy.
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Affiliation(s)
- Luis A Robles
- Section of Neurosurgery, Hospital CMQ Premier, Puerto Vallarta, Jalisco, Mexico.
| | - Antonio F Matilla
- Section of Internal Medicine, Hospital CMQ Premier, Puerto Vallarta, Jalisco, Mexico
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32
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Moskalik AD, Graber MR, Lakshminarayanan S, Bulsara KR. Sarcoid Infiltration of the Skull with Epidural Extension: Case Report and Literature Review. World Neurosurg 2020; 139:253-259. [PMID: 32305608 DOI: 10.1016/j.wneu.2020.04.008] [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: 03/23/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sarcoidosis is a granulomatous disease most often affecting the lungs, but extrapulmonary manifestations are also common. While virtually any organ system can be involved, skeletal manifestations are present in 1%-13% of cases. Skull lesions are even more rare. We found 14 case reports describing symptomatic skull lesions in patients with no prior history of sarcoid to better understand the symptomology and disease progression. CASE DESCRIPTION Here we present the case of a 57-year-old female with history of sarcoidosis and new-onset forgetfulness, confusion, and headaches who was found to have multiple skull lesions with epidural extension. On histopathologic examination of the excised lesion, noncaseating granulomas were observed and diagnoses of skull sarcoidosis and neurosarcoid were made. Since the patient was actively treated with corticosteroids, the plan was to initiate infliximab. CONCLUSION Sarcoidosis affecting the skull and central nervous system is exceedingly rare and can mimic many pathologies including metastatic bone disease, multiple myeloma, and eosinophilic granulomatosis. With a wide differential, surgical specimen is needed for concrete diagnosis and treatment. While the rates of skeletal involvement are low, a skeletal survey might be an important step in monitoring disease burden in patients, especially as lesions can be asymptomatic.
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Affiliation(s)
- Anzhela D Moskalik
- University of Connecticut School of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Melanie R Graber
- Department of Primary Care Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
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33
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Demaria L, Borie R, Benali K, Piekarski E, Goossens J, Palazzo E, Forien M, Dieudé P, Crestani B, Ottaviani S. 18F-FDG PET/CT in bone sarcoidosis: an observational study. Clin Rheumatol 2020; 39:2727-2734. [PMID: 32198555 DOI: 10.1007/s10067-020-05022-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Bone sarcoidosis is usually rare. Imaging procedures such as fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) can reveal bone sarcoidosis with better sensitivity than conventional radiography. We aimed to describe bone sarcoidosis involvement detected with 18F-FDG PET/CT. METHODS This was an observational retrospective study of individuals with pulmonary sarcoidosis who underwent 18F-FDG PET/CT. According to the ATS/ERS/WASOG criteria, sarcoidosis was diagnosed by the presence of clinical and/or imaging features of sarcoidosis and evidence of non-caseating epithelioid granulomas on a biopsy. We assessed clinical and 18F-FDG PET/CT characteristics. RESULTS Data for 85 patients with sarcoidosis (56.5% female, median age 47 [range 21-80] years) were analyzed. The median follow-up was 4 years. Among 56 patients, sarcoidosis occurred in more than three organs. According to ATS/ERS/WASOG criteria, bone sarcoidosis was diagnosed in 12 (14%) patients. The spine was the most commonly affected location (92%, n = 11), followed by the pelvis (67%, n = 8), sternum (33%, n = 4), humerus (25%, n = 3), and fingers (17%, n = 2). Only peripheral adenopathy was associated with bone sarcoidosis (p = 0.04). Seven patients had a 18F-FDG PET/CT follow-up, all showing a decrease of bone lesions. CONCLUSION Bone sarcoidosis occurred in 14% of patients with sarcoidosis, affecting multiple bones and mostly the axial skeleton. 18F-FDG PET/CT seems a sensitive tool for diagnosis and follow-up of bone sarcoidosis.
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Affiliation(s)
- Lucie Demaria
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Raphael Borie
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Khadija Benali
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Médecine Nucléaire, Paris, France
| | - Eve Piekarski
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Médecine Nucléaire, Paris, France
| | - Julia Goossens
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Elisabeth Palazzo
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Marine Forien
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Philippe Dieudé
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Bruno Crestani
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Sébastien Ottaviani
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France.
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Osseous Sarcoid Mimicking Metastatic Cancer. Am J Med Sci 2020; 359:387-388. [PMID: 32171468 DOI: 10.1016/j.amjms.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/09/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
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TNF inhibitor treating osseous sarcoidosis and dactylitis: case and literature review. Clin Rheumatol 2020; 39:2219-2222. [PMID: 32020444 DOI: 10.1007/s10067-020-04964-1] [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: 11/20/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
A 49-year-old African American male with multiorgan sarcoidosis presented with recurrent episodes of dactylitis and arthritis. Imaging had shown sarcoid osseous involvement of both hands. This would improve temporarily with high-dose corticosteroids but once tapered, he would experience recurrent flares. Despite several different oral immunosuppressant regimens, significant improvement was only observed after the initiation of adalimumab. Not only was adalimumab successful in symptomatic relief, in addition, patient continues to be in remission with no recurrent episodes of dactylitis. Prednisone was successfully tapered from 40 to 3 mg daily. This improvement with TNF inhibitors has been reported with other manifestations of sarcoidosis including pulmonary and ocular involvements. Osseous sarcoidosis is a very rare presentation, and little information regarding treatment with TNF inhibitors is available. TNF inhibitors should be considered as the next-step therapy in resistant cases of osseous sarcoidosis and dactylitis not responding to corticosteroids and traditional immunosuppressant therapy.
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Affiliation(s)
- Lisa V Maher
- From the University of Mississippi Medical Center, Jackson, MS, USA
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Resolution of Osseous Sarcoidosis with Methotrexate. Case Rep Rheumatol 2019; 2019:4156313. [PMID: 31886004 PMCID: PMC6925686 DOI: 10.1155/2019/4156313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022] Open
Abstract
Though a relatively uncommon manifestation of sarcoidosis, some clinicians are tasked with managing osseous involvement of disease, and the optimal treatment approach in this setting is not well established. Previous studies have shown variable efficacy for osseous sarcoidosis utilizing multiple agents alone or in combination, often using imaging follow-up in conjunction with clinical assessment to evaluate response to treatment. We present a case of widespread skeletal involvement of sarcoidosis without evidence of concurrent pulmonary disease demonstrating marked clinical improvement and near-complete resolution of imaging abnormalities on magnetic resonance imaging (MRI) following the use of methotrexate as the primary pharmacologic agent.
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Ben Hassine I, Rein C, Comarmond C, Glanowski C, Saidenberg-Kermanac’h N, Meunier B, Schleinitz N, Chanson N, Sacré K, Scherlinger M, Richez C, Hirschi S, Groh M, Devilliers H, Bielefeld P, Saadoun D, Chapelon-Abric C, Arnaud L, Cacoub P. Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients. Joint Bone Spine 2019; 86:789-793. [DOI: 10.1016/j.jbspin.2019.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
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Shariatmaghani S, Salari R, Sahebari M, Tabrizi PS, Salari M. Musculoskeletal Manifestations of Sarcoidosis: A Review Article. Curr Rheumatol Rev 2019; 15:83-89. [PMID: 29692254 DOI: 10.2174/1573397114666180425111901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/06/2018] [Accepted: 04/12/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sarcoidosis is a multisystem inflammatory disease with an etiology that is not clearly understood. Amongst the different organs that may be affected, the lungs are the most common. Musculoskeletal manifestations of the disease are uncommon. OBJECTIVES They include arthropathy, bone lesions, or myopathy, all of which may occur as initial symptoms or develop during the course of the disease. METHODS Articular involvement my present as arthralgia or arthritis. Skeletal complications usually develop in the chronic state of the disease. Muscular disease is rare and usually asymptomatic. Appropriate imaging modalities including X-ray, MRI, FDG-PET/CT assist in the diagnosis of rheumatic sarcoidosis. However, biopsy is necessary for definite diagnosis. RESULT AND CONCLUSION In most cases of musculoskeletal involvement, NSAIDs and corticosteroids are sufficient for symptomatic management. For more resistant cases immunosuppressive drugs (i.e., methotrexate) and TNF- inhibitors are used. Our aim is to review various types of musculoskeletal involvement in sarcoidosis and their existing treatment options.
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Affiliation(s)
- Somayeh Shariatmaghani
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Salari
- Department of Clinical Persian Pharmacy, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payman Shalchian Tabrizi
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Salari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Thirunavukarasu V, Thirunavukarasu C, Willis T, Tsahtsarlis A. Osseous Sarcoidosis with a Solitary Lytic Skull Lesion: A Case Report. J Neurol Surg Rep 2019; 80:e27-e29. [PMID: 31263654 PMCID: PMC6599058 DOI: 10.1055/s-0039-1687845] [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: 03/22/2018] [Accepted: 01/18/2019] [Indexed: 11/05/2022] Open
Abstract
Bone sarcoidosis is an uncommon manifestation of the multisystemic disease with skull involvement being rare. We present the case of a 32-year-old female who was referred by her General Practitioner with a left calvarial lesion on a background of previous unilateral 7th nerve palsy and diabetes mellitus. Images demonstrated a left frontoparietal calvarial osteolytic lesion. She underwent resection by the neurosurgical team with histopathological study revealing noncaseating granulomas, consistent with sarcoidosis. Given absence of other systemic features of sarcoidosis, she did not undergo systemic treatment.
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Affiliation(s)
| | - Caitlin Thirunavukarasu
- Department of Internal Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Timothy Willis
- Department of Anatomical Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Antonio Tsahtsarlis
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Sharma D, Narula N, Mudduluru B, Joseph B, Elsayegh D. Osseous Sarcoma: Is Sarcoma the New Emperor of Maladies? Case-Series with Brief Review of the Literature. Case Rep Pulmonol 2019; 2019:5602827. [PMID: 31186975 PMCID: PMC6521550 DOI: 10.1155/2019/5602827] [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: 01/25/2019] [Revised: 03/20/2019] [Accepted: 04/16/2019] [Indexed: 11/22/2022] Open
Abstract
Sarcoidosis is multisystem disease that has been amusing physicians since its discovery in 1989 by Caesar Boeck. More than 10,000 articles have been published in the literature by far, and each time it affects a new organ. Involvement of bone has been recently discovered and because it is still a rare entity, it is important to focus on the presenting systems and also to be able to differentiate it from other closely related diseases including but not limited to tumor and other infectious processes. We describe two cases of osseous sarcoma in two relatively young but surprisingly asymptomatic patients.
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Affiliation(s)
- Dikshya Sharma
- Department of Pulmonary and Critical Care, Staten Island University Hospital, Staten Island, New York 10305, USA
| | - Naureen Narula
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York 10305, USA
| | - Bindu Mudduluru
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York 10305, USA
| | - Bino Joseph
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York 10305, USA
| | - Dany Elsayegh
- Department of Pulmonary and Critical Care, Staten Island University Hospital, Staten Island, New York 10305, USA
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Cartayrade N, Lapègue F, Cambon Z, Sans N, Faruch M. Case 264: A Case of Osseous Sarcoidosis. Radiology 2019; 291:261-266. [DOI: 10.1148/radiol.2019162264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Noëlle Cartayrade
- From the Department of Radiology, CHU Toulouse-Purpan, Place du docteur Baylac, 31059 Toulouse Cedex 9, France
| | - Franck Lapègue
- From the Department of Radiology, CHU Toulouse-Purpan, Place du docteur Baylac, 31059 Toulouse Cedex 9, France
| | - Zoé Cambon
- From the Department of Radiology, CHU Toulouse-Purpan, Place du docteur Baylac, 31059 Toulouse Cedex 9, France
| | - Nicolas Sans
- From the Department of Radiology, CHU Toulouse-Purpan, Place du docteur Baylac, 31059 Toulouse Cedex 9, France
| | - Marie Faruch
- From the Department of Radiology, CHU Toulouse-Purpan, Place du docteur Baylac, 31059 Toulouse Cedex 9, France
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Sigaux J, Semerano L, Nasrallah T, Nunes H, Bouvry D, Valeyre D, Boissier MC, Saidenberg-Kermanac'h N. High prevalence of spondyloarthritis in sarcoidosis patients with chronic back pain. Semin Arthritis Rheum 2019; 49:246-250. [PMID: 31138443 DOI: 10.1016/j.semarthrit.2019.03.006] [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: 12/21/2018] [Revised: 02/14/2019] [Accepted: 03/04/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Chronic back pain (CBP) is a frequent complaint in patients with sarcoidosis, which challenges the clinician as multiples causes may potentially underlie this symptom. Interestingly, some reports suggest that the coexistence of sarcoidosis and spondyloarthritis (SpA) may be frequent. This study aimed to determine the prevalence of axial radiographic and non-radiographic SpA in patients with sarcoidosis and CBP and assess the association between patient characteristics and SpA. METHODS This cross-sectional study enrolled 64 patients with a diagnosis of sarcoidosis and CBP. Patients describing CBP underwent a full spine MRI and radiography. All patients with inflammatory CBP underwent complementary sacroiliac joint MRI. The diagnosis of axial SpA was based on the Assessment of SpondyloArthritis International Society classification criteria. RESULTS Among the 64 patients (49 women) with sarcoidosis and CBP, 29 had inflammatory pain; 15/64 had a diagnosis of SpA (23.4% [95% CI: 13.7-35.6], 14/29 (48.3% [95% CI: 29.5-67.5] of those with inflammatory back pain). MRI sacroiliitis was found in 13 patients. On both univariate and multivariate analysis, SpA diagnosis was associated with inflammatory CBP (OR=28.5, 95% CI: 1.91-425.4) and sarcoidosis limited to the thorax (OR=6.74, 95% CI: 1.08-42.1). SpA was associated with young age (p = 0.0093) and male sex (p = 0.021) only on univariate analysis. Besides, 12/64 patients (18.8%, 95% CI: 10.1-30.5) had a diagnosis of sarcoidosis spine bone lesions, 7/64 (10.9%, 95% CI: 4.5-21.2) symptomatic vertebral fracture and 30/64 (46.9%, 95% CI: 34.3-59.8) degenerative spine. CONCLUSIONS The prevalence of SpA is increased in sarcoidosis patients with inflammatory back pain. The systematic use of spine and sacroiliac MRI in this subgroup is justified. The association between other patient features and SpA needs further confirmation.
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Affiliation(s)
- Johanna Sigaux
- Inserm UMR 1125, 1 rue de Chablis, 93009 Bobigny, France; Sorbonne Paris Cité, Université Paris 13, 1 rue de Chablis, 93009 Bobigny, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Luca Semerano
- Inserm UMR 1125, 1 rue de Chablis, 93009 Bobigny, France; Sorbonne Paris Cité, Université Paris 13, 1 rue de Chablis, 93009 Bobigny, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France
| | - Toufik Nasrallah
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France
| | - Hilario Nunes
- Sorbonne Paris Cité, Université Paris 13, 1 rue de Chablis, 93009 Bobigny, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France; EA2363, 1 rue de Chablis, 93009 Bobigny, France
| | - Diane Bouvry
- Sorbonne Paris Cité, Université Paris 13, 1 rue de Chablis, 93009 Bobigny, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France; EA2363, 1 rue de Chablis, 93009 Bobigny, France
| | - Dominique Valeyre
- Sorbonne Paris Cité, Université Paris 13, 1 rue de Chablis, 93009 Bobigny, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France; EA2363, 1 rue de Chablis, 93009 Bobigny, France
| | - Marie-Christophe Boissier
- Inserm UMR 1125, 1 rue de Chablis, 93009 Bobigny, France; Sorbonne Paris Cité, Université Paris 13, 1 rue de Chablis, 93009 Bobigny, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France
| | - Nathalie Saidenberg-Kermanac'h
- Inserm UMR 1125, 1 rue de Chablis, 93009 Bobigny, France; Sorbonne Paris Cité, Université Paris 13, 1 rue de Chablis, 93009 Bobigny, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Groupe Hospitalier "Hôpitaux Universitaires de Paris-Seine Saint-Denis", 125, rue de Stalingrad, 93009 Bobigny, France
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Miller ER, Fanta CH, McSparron JI, Pan B, Coblyn JS, Sparks JA. Musculoskeletal and pulmonary outcomes of sarcoidosis after initial presentation of osseous involvement. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2019; 36:60-73. [PMID: 30918438 PMCID: PMC6433168 DOI: 10.36141/svdld.v36i1.7326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to investigate the musculoskeletal and pulmonary outcomes of patients with osseous sarcoidosis. METHODS We identified 24 patients with osseous sarcoidosis and at least one year of follow-up after diagnosis (baseline). We collected outcome data at 1-year follow-up and last follow-up. We defined a composite outcome measure; worsening considered as worsening in any of the following 4 components compared to baseline: 1) osseous sarcoidosis symptoms, 2) musculoskeletal imaging of affected bone, 3) chest imaging, or 4) pulmonary function testing (PFT). RESULTS A minority of patients had a worsening composite outcome at 1-year (9/24, 38%) and last follow-up (5/24, 21%). When only considering musculoskeletal symptoms and imaging, only 25% (6/24) and 13% (3/24) of patients worsened compared to baseline at 1-year and last follow-up, respectively. Patients with a worsening composite overall outcome tended to be older at baseline than those without the outcome for both 1-year (54.3 years vs. 47.5 years, p=0.11) and last follow-up (55.0 years vs. 48.7 years; p=0.23), although these differences were non-significant. Treatment was not associated with worsening composite overall outcome at 1-year follow-up (p=0.40), but was significantly associated with decreased risk for worsening at last follow-up (p=0.05). CONCLUSIONS In this retrospective cohort study of osseous sarcoidosis, most patients had a favorable outcome according to symptoms, musculoskeletal/chest imaging, and PFTs, even though only a minority were treated with glucocorticoids or DMARDs. These results suggest that the natural history of osseous sarcoidosis is often benign, although some patients experience clinical progression.
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Affiliation(s)
- Ezra Ross Miller
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | - Christopher H. Fanta
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | | | - Beatrice Pan
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jonathan S. Coblyn
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey A. Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Brandão Guimarães J, Nico MA, Omond AG, Silva FD, Aivazoglou LU, Carneiro BC, Fernandes ARC. Radiologic Manifestations of Musculoskeletal Sarcoidosis. Curr Rheumatol Rep 2019; 21:7. [PMID: 30762131 DOI: 10.1007/s11926-019-0806-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review article is to present the spectrum of abnormalities and multi-modality imaging evaluations in patients with musculoskeletal sarcoidosis. RECENT FINDINGS The articular manifestations of sarcoidosis are difficult to distinguish from those of the other inflammatory and degenerative arthropathies, and the muscular lesions in sarcoidosis are generally clinically silent and therefore often missed. Magnetic resonance imaging has shown these manifestations to be very common in active sarcoidosis, and should thus be included in the screening if musculoskeletal sarcoidosis is suspected. The clinician should consider magnetic resonance imaging for the evaluation of patients with sarcoidosis who have unexplained osteoarticular complaints if standard radiographs are negative. Furthermore, radiologists should include sarcoidosis in the differential diagnosis of musculoskeletal disease detected at magnetic resonance imaging in the appropriate clinical setting.
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Affiliation(s)
- Júlio Brandão Guimarães
- Department of Radiology, Grupo Osteomuscular, Fleury Medicina e Saúde, São Paulo, Brazil. .,Department of Radiology, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil. .,Department of Radiology and Biomedical Imaging, University of California, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
| | - Marcelo A Nico
- Department of Radiology, Grupo Osteomuscular, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Alípio G Omond
- Department of Radiology, Grupo Osteomuscular, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Flávio D Silva
- Department of Radiology, Grupo Osteomuscular, Fleury Medicina e Saúde, São Paulo, Brazil.,Department of Radiology, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Laís Uyeda Aivazoglou
- Department of Radiology, Grupo Osteomuscular, Fleury Medicina e Saúde, São Paulo, Brazil.,Department of Radiology, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno C Carneiro
- Department of Radiology, Grupo Osteomuscular, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Artur R C Fernandes
- Department of Radiology, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
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Sahli H, Bachali A, Amri R, Bouzaidi K, Tekaya R. Traitement par méthotrexate lors d’une sarcoïdose osseuse digitale multifocale : à propos d’un cas. Therapie 2018; 73:547-549. [PMID: 29980295 DOI: 10.1016/j.therap.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/08/2017] [Accepted: 05/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Hana Sahli
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine interne, hôpital universitaire Maamouri, 8000 Nabeul, Tunisie
| | - Asma Bachali
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Laboratoire de biologie médicale, hôpital universitaire Maamouri, 8000 Nabeul, Tunisie.
| | - Raja Amri
- Service de médecine interne, hôpital universitaire Maamouri, 8000 Nabeul, Tunisie
| | - Khaled Bouzaidi
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de radiologie, hôpital universitaire Maamouri, 8000 Nabeul, Tunisie
| | - Rawdha Tekaya
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de rhumatologie, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
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Bechman K, Christidis D, Walsh S, Birring SS, Galloway J. A review of the musculoskeletal manifestations of sarcoidosis. Rheumatology (Oxford) 2018; 57:777-783. [PMID: 28968840 DOI: 10.1093/rheumatology/kex317] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Indexed: 01/09/2023] Open
Abstract
Sarcoidosis is a systemic disease of unknown aetiology that is characterized by granulomatous inflammation that can develop in almost any organ system. Musculoskeletal manifestations are seen in up to one-third of patients, ranging from arthralgia through to widespread destructive bone lesions. Inflammatory tendon lesions and periarticular swelling are more common than true joint synovitis. Despite advances in our understanding of the pathophysiology of the disease, diagnosis remains challenging. Definitive diagnosis, irrespective of organ site involvement, hinges on histological confirmation of non-caseating granuloma combined with an appropriate clinical syndrome. Musculoskeletal involvement usually develops early in the disease course. Imaging modalities, particularly fluorodeoxyglucose PET, are helpful in delineating the extent of involvement and measuring disease activity. Bone involvement may only become apparent following isotope imaging. Corticosteroids remain the cornerstone of treatment. MTX is the steroid-sparing agent of choice unless there is renal involvement. Biologic therapies are sometimes used in severe disease, although the evidence base for efficacy is inconsistent.
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Affiliation(s)
- Katie Bechman
- Academic Department of Rheumatology, King's College London, London, UK
| | - Dimitrios Christidis
- Rheumatology Department, Epsom and St Helier's Hospital NHS Foundation Trust, Carshalton, UK
| | - Sarah Walsh
- Dermatology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - James Galloway
- Academic Department of Rheumatology, King's College London, London, UK
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Marks R, Engelhardt M, Hager S, Füllgraf H, Südkamp NP, Herget GW. Diffuse large B cell lymphoma (DLBCL): bilateral vanishing tibiae. Ann Hematol 2018; 97:1497-1500. [PMID: 29574568 DOI: 10.1007/s00277-018-3308-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Reinhard Marks
- Department of Hematology, Oncology and Stem-Cell Transplantation, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Hematology, Oncology and Stem-Cell Transplantation, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Sven Hager
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Hannah Füllgraf
- Department of Pathology, Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Georg W Herget
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Abstract
PURPOSE OF REVIEW Vitamin D supplementation is widespread used in the general population. In sarcoidosis, up to 50% of patients, especially postmenopausal women and those taking corticosteroids, show evidence of increased bone fragility. The purpose of this review is to provide an evidence-based rationale on how to treat sarcoidosis patients with bone health issues. RECENT FINDINGS Evidence from observational studies show that decreased 25-hydroxy vitamin D is common in sarcoidosis. However, the great majority of sarcoidosis patents have normal or often elevated levels of 1,25-dihydroxy vitamin D (calcitriol), a marker associated with disease activity. High calcitriol levels may often be associated with hypercalcemia and hypercalcuria. The few interventional randomized controlled studies in the field, suggest that vitamin D supplementation may not be well tolerated because of hypercalcemia, moreover without substantial benefit on bone health and risk for fractures in these patients. SUMMARY Vitamin D supplementation may be withheld in sarcoidosis patients with bone fragility, unless calcitriol levels are below normal limits. A treating scheme is proposed.
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Tanaka Y, Taima K, Tanaka H, Itoga M, Ishioka Y, Shiratori T, Tsuchiya J, Sakamoto H, Takanashi S, Tasaka S. Emergency Radiotherapy for Spinal Cord Compression due to Bone Sarcoidosis. Intern Med 2018; 57:717-720. [PMID: 29151512 PMCID: PMC5874346 DOI: 10.2169/internalmedicine.9299-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sarcoidosis is an inflammatory granulomatous disease that is systemic, but bone involvement is uncommon. A 68-year-old man was referred to our hospital complaining of right shoulder pain with numbness. Computed tomography revealed systemic lymphadenopathy and multiple bone lesions. Because malignant lymphoma with a mass lesion protruding into the vertebral canal was considered, he underwent urgent radiotherapy. Thereafter, a needle biopsy of the left parasternal node was performed and showed epithelioid granulomas, confirming a diagnosis of sarcoidosis. Since his neurologic symptoms improved, the patient was not given systemic corticosteroids. Radiotherapy may be useful for local control of bone sarcoidosis.
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Affiliation(s)
- Yoshihito Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Kageaki Taima
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Masamichi Itoga
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Yoshiko Ishioka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Toshihiro Shiratori
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Junichiro Tsuchiya
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Hiroaki Sakamoto
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Shingo Takanashi
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
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