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Abdelghaffar M, Hwang E, Damsky W. Cutaneous Sarcoidosis. Clin Chest Med 2024; 45:71-89. [PMID: 38245372 DOI: 10.1016/j.ccm.2023.08.004] [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] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a multisystem disease that most commonly affects the lungs, lymphatic system, eyes, and skin but any organ may be involved. Cutaneous sarcoidosis most commonly presents as pink-red to red-brown papules and plaques that commonly affect the head and neck. With the skin being readily accessible for evaluation and biopsy, when sarcoidosis is suspected, dermatologic evaluation may be helpful for establishing a definitive diagnosis. Treatment strategy depends on the severity and distribution of skin lesions and should incorporate patient preference and treatment considerations for other organs that may be involved.
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Affiliation(s)
- Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Erica Hwang
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, LCI 501 PO Box 208059, New Haven, CT 06520, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, LCI 501 PO Box 208059, New Haven, CT 06520, USA; Department of Pathology, Yale School of Medicine, 310 Cedar Street, LH 108, PO Box 208023, New Haven, CT 06520, USA.
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Kwon YS, Jung HI, Kim HJ, Lee JW, Choi WI, Kim JY, Rho BH, Lee HW, Kwon KY. Isolated cervical lymph node sarcoidosis presenting in an asymptomatic neck mass: a case report. Tuberc Respir Dis (Seoul) 2013; 75:116-9. [PMID: 24101936 PMCID: PMC3790023 DOI: 10.4046/trd.2013.75.3.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/14/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-α in the granuloma. However, transforming growth factor-β was not expressed, although interleukin-1β was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma.
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Affiliation(s)
- Yong Shik Kwon
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Abstract
Arrhythmias in a Patient With Sarcoidosis. Sarcoidosis is a multisystemic granulomatous disease of unknown etiology; up to 27% of cases entail cardiac involvement. Conduction abnormalities and ventricular tachycardia are the most common arrhythmias and can cause sudden death. We describe a patient who developed cardiac sarcoidosis 9 years after undergoing surgery for neurosarcoidosis. He presented with 2:1 second-degree atrioventricular block. Ventricular tachycardia with 3 morphologies was induced by exercise stress test. A DDD pacer/implantable cardioverter defibrillator (ICD) was implanted, which prevented exercise-induced ventricular tachycardia in a follow-up stress test. Treatment with steroids was initiated. The AVB disappeared, and no further arrhythmias were documented at the 1-year follow-up.
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Affiliation(s)
- José L Serra
- Cardiovascular Unit, Sanatorio Allende, Córdoba, Argentina.
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Adaptive immune responses in primary cutaneous sarcoidosis. Clin Dev Immunol 2011; 2011:235142. [PMID: 21603192 PMCID: PMC3095245 DOI: 10.1155/2011/235142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Accepted: 01/27/2011] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is a multisystemic inflammatory disorder with cutaneous lesions present in about one-quarter of the patients. Cutaneous lesions have been classified as specific and nonspecific, depending on the presence of nonnecrotizing epithelial cell granulomas on histologic studies. The development and progression of specific cutaneous sarcoidosis involves a complex interaction between cells of the adaptive immune systems, notably T-lymphocytes and dendritic cells. In this paper, we will discuss the role of T-cells and skin dendritic cells in the development of primary cutaneous sarcoidosis and comment on the potential antigenic stimuli that may account for the development of the immunological response. We will further explore the contributions of selected cytokines to the immunopathological process. The knowledge of the adaptive immunological mechanisms operative in cutaneous sarcoidosis may subsequently be useful for identifying prevention and treatment strategies of systemic sarcoidosis.
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Abstract
Various nonfollicular scalp conditions can cause secondary scarring or permanent alopecia. Possible causes are congenital defects, trauma, inflammatory conditions, infections, and neoplasms (rarely drugs). Associated signs and symptoms and other diagnostic procedures such as histopathology may aid in the diagnosis. Detection of the underlying disorder may be difficult in end-stage lesions. Treatment is specific for active conditions. Surgery and hair transplantation are options for localized scars.
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Abstract
Sarcoidosis is a multisystem disease with cutaneous lesions present in 20%-35% of patients. Given the wide variability of clinical manifestations, it is one of the "great imitators," making it necessary to consider clinical, epidemiological, radiographic, laboratory, and histopathological criteria to make the diagnosis. Cutaneous lesions have been classified as specific and nonspecific, depending on the presence of noncaseating granulomas on histologic studies. Specific lesions include maculopapules, plaques, nodules, lupus pernio, scar infiltration, alopecia, ulcerative lesions, and hypopigmentation among others. Nail, mucosal, and childhood sarcoidosis represent a distinct subset of the disease process. The most common nonspecific lesion is erythema nodosum. Others include calcifications, prurigo, erythema multiforme, nail clubbing, and Sweet syndrome. The importance of considering cutaneous sarcoidosis in the clinical differential diagnosis of a given skin lesion relies on the association with systemic involvement and the convenience of the skin as a tissue source for histologic analysis.
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Affiliation(s)
- Esteban Fernandez-Faith
- Department of Dermatology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Maples CJ, Counselman FL. Lupus pernio. J Emerg Med 2007; 33:187-9. [PMID: 17692772 DOI: 10.1016/j.jemermed.2006.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 10/20/2006] [Accepted: 11/29/2006] [Indexed: 11/23/2022]
Affiliation(s)
- Christopher J Maples
- Department of Emergency Medicine, Eastern Virginia Medical School and Emergency Physicians of Tidewater, Norfolk, Virginia, USA
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Abstract
BACKGROUND Granulomatous dermatitis frequently presents a diagnostic challenge to dermatopathologists because an identical histologic picture is produced by several causes, and conversely, a single cause may produce varied histologic patterns. METHODS A retrospective analysis of skin biopsies received over a period of 7 years was performed, and cases of non-infectious granulomatous dermatitis diagnosed on histopathological examination were retrieved. RESULTS Out of a total of 586 cases of granulomatous dermatitis, 71 cases (12.11%) were categorized as non-infectious granulomatous dermatitis on the basis of clinicopathological findings. Further subcategorization was done based on morphology of granulomas as epithelioid granulomas; 15 cases of sarcoidosis, 21.1%, one case of Crohn's vulvitis, 1.4%, necrobiotic granulomas; 11 cases of granuloma annulare, 15.4%, two cases of rheumatoid nodule, 2.8%, 10 cases of foreign body granulomas, 14.0%; 32 cases of miscellaneous group, 45%. CONCLUSIONS Morphology alone is seldom specific and cannot be used as a diagnostic tool for identification of specific diseases. Adequate clinical data and work up in combination of pathological resources can help in elucidation of specific etiology of granulomatous dermatitis. Mohan H, Bal A, Dhami GP. Non-infectious granulomatous dermatitis: a clinicopathological study.
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Affiliation(s)
- Harsh Mohan
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India.
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Spiegel IB, White SD, Foley JE, Drazenovich NL, Ihrke PJ, Affolter VK. A retrospective study of cutaneous equine sarcoidosis and its potential infectious aetiological agents. Vet Dermatol 2006; 17:51-62. [PMID: 16412120 DOI: 10.1111/j.1365-3164.2005.00494.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Nine horses from ages 5 to 21 years were diagnosed with cutaneous equine sarcoidosis (ES) over an 18-year period. In addition to skin, the lungs were frequently involved, with other organ systems affected less commonly. A predisposition for thoroughbreds and geldings was noted. Cutaneous lesions and signs included crusts, scales, alopecia and pruritus. These were found at various sites, particularly the legs/thighs/elbows, thorax, neck, face and ventral abdomen. Three horses were euthanized shortly after hospitalization; others survived as long as 12 years. Histopathologic stains, immunohistochemistry and polymerase chain reaction assays on paraffin-embedded cutaneous specimens from eight horses for Mycobacterium spp., Coccidioides immitis, Cryptococcus neoformans, Corynebacterium pseudotuberculosis, and Borrelia burgdorferi were all negative. The aetiology of ES is unlikely microbial and continues to be a diagnosis of exclusion. ES, when limited to the skin, is associated with a good prognosis, with either partial or complete response to glucocorticoid therapy in all the surviving horses.
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Affiliation(s)
- Ian B Spiegel
- Veterinary Medical Teaching Hospital, University of California, Davis, California 95616, USA.
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Abstract
Sarcoidosis is a multiorgan granulomatous disease, the most common head and neck manifestation of which is cervical lymphadenopathy. Only the presentation of sarcoidal granuloma in cervical lymph nodes without typical manifestations of systemic sarcoidosis poses a diagnostic difficulty. We describe the case of a 39-year-old male who had a 2-month history of a progressively increasing mass with soreness in his right neck. The biopsy from the neck mass demonstrated non-caseating epithelioid cell granuloma of the lymph nodes. The differential diagnoses of mycobacterial or fungal infections were excluded. Thoracic evaluations, including chest X-ray and high-resolution computed tomography, revealed no abnormal findings. Treatment with systemic corticosteroids resulted in improved clinical symptoms. No recurrence of the neck mass or other signs of systemic sarcoidosis were noted during 1.5 years of follow-up. Although our patient's definitive diagnosis could not be determined, the case highlights 2 important issues: sarcoidal granuloma in lymph nodes may be a precursor of sarcoidosis, even in the absence of pulmonary or other systemic involvement; and regular follow-up is recommended in such cases.
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Affiliation(s)
- Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Gold BD, Westra SJ, Graeme-Cook FM. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-2003. A 14-month-old boy with recurrent abdominal distention and diarrhea. N Engl J Med 2003; 349:2541-9. [PMID: 14695415 DOI: 10.1056/nejmcpc030030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Abdominal Pain/etiology
- Adult
- Colitis, Ulcerative/complications
- Colitis, Ulcerative/drug therapy
- Diagnosis, Differential
- Diarrhea, Infantile/etiology
- Enterocolitis/complications
- Enterocolitis/microbiology
- Enterocolitis/pathology
- Enterocolitis, Necrotizing/diagnosis
- Female
- Gastrointestinal Diseases/diagnosis
- Humans
- Infant
- Infections/diagnosis
- Infectious Disease Transmission, Vertical
- Intestine, Small/diagnostic imaging
- Intestine, Small/pathology
- Intestine, Small/surgery
- Lung/diagnostic imaging
- Male
- Mycobacterium tuberculosis/isolation & purification
- Sarcoidosis/diagnosis
- Tomography, X-Ray Computed
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/pathology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnostic imaging
- Tuberculosis, Pulmonary/transmission
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Mahnke N, Medve-Koenigs K, Megahed M, Neumann NJ. [Medium-dose UV-A1 phototherapy. Successful treatment of cutaneous sarcoidosis]. DER HAUTARZT 2003; 54:364-6. [PMID: 12669212 DOI: 10.1007/s00105-003-0503-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 82-year-old female had a 2-year history of cutaneous sarcoidosis without systemic involvement. Various treatments including local glucocorticosteroids and tacrolimus ointment had failed. Therefore, we treated our patient with medium-dose UVA1 phototherapy. After 50 sessions with a total dose of 2.640 J/cm(2) all lesions had disappeared. Clinical follow up showed no recurrence of skin lesions after 5 months.
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Affiliation(s)
- N Mahnke
- Universitätshautklinik, Düsseldorf
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