1
|
Crohn’s Disease Diagnosed in a Man with Sarcoidosis: Coincidence or Correspondence? Case Rep Gastrointest Med 2022; 2022:5943468. [PMID: 35669381 PMCID: PMC9166977 DOI: 10.1155/2022/5943468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Crohn's disease and sarcoidosis are characterized by noncaseating granulomas, but rarely do they present in the same patient. Their coexistence presents a diagnostic challenge as they are often classified as clinically separate, despite their similarities. We present a case of a 59-year-old man previously diagnosed with pulmonary sarcoidosis who presented to the emergency room with abdominal pain and diarrhea. Colonoscopy revealed multiple ulcers in the colon, with histology in keeping with newly diagnosed Crohn's colitis. The patient had a good clinical response to initiation of steroid therapy and a tumor necrosis factor (TNF) inhibitor.
Collapse
|
2
|
Paone G, Steffanina A, De Rose G, Leonardo G, Colombo D, Ricci P, Sabetta F, Vaccaro F, Rosato E, Palange P. A life-threatening small bowel obstruction as onset of an unknown sarcoidosis: A case report. Respir Med Case Rep 2021; 33:101379. [PMID: 33786300 PMCID: PMC7994781 DOI: 10.1016/j.rmcr.2021.101379] [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: 04/18/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown etiology characterized by non-caseating granulomas at the site of disease. A confident diagnosis should be established by the evidence of typical granulomas on biopsy and after exclusion of other conditions. Clinically recognizable Gastrointestinal involvement (GI) occurs in less than 1.6% of patients with sarcoidosis, with data revealing small intestine participation in 0.03% of the cases and few anecdotal reports describe a peritoneal presentation. Clinical manifestations of peritoneal sarcoidosis are abdominal discomfort, bloating, weight loss, epigastric and peri-umbilical pain with or without ascites, bowel obstruction. Treatment depends on symptoms and disease activity. Herein we describe the case of a 42-years-old male patient who developed an acute, life–threatening small bowel obstruction as first manifestation of sarcoidosis. To the best of our knowledge, this is the only report showing such extensive and acute onset of intra-abdominal sarcoidosis in the absence of a previous disease manifestation and without pulmonary involvement. Abdominal sarcoidosis is a sporadic event and localization without pulmonary involvement is rarer mimicking GI diseases. Reaching abdominal sarcoidosis diagnosis is not a straightforward process. It is pivotal to confirm sarcoidosis diagnosis before subjecting patients to an appropriate treatment. Corticosteroids are considered the cornerstone treatment. Asymptomatic patients may undergo a watch and wait follow-up with no need for a pharmacological therapy. Surgery is not often required but individualized patient evaluation is recommended.
Collapse
Affiliation(s)
- Gregorino Paone
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic, Geriatric Sciences La Sapienza University of Rome, Rome, Italy.,Department of Public Health and Infectious Diseases, La Sapienza University of Rome, Rome, Italy
| | | | - Giulia De Rose
- Department of Public Health and Infectious Diseases, La Sapienza University of Rome, Rome, Italy
| | | | - Daniele Colombo
- Department of Biomedicine and Prevention, Anatomic Pathology Section, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Ricci
- Department of Radiology, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Vaccaro
- Department of Public Health and Infectious Diseases, La Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, La Sapienza University of Rome, Rome, Italy
| |
Collapse
|
3
|
Tana C, Donatiello I, Coppola MG, Ricci F, Maccarone MT, Ciarambino T, Cipollone F, Giamberardino MA. CT Findings in Pulmonary and Abdominal Sarcoidosis. Implications for Diagnosis and Classification. J Clin Med 2020; 9:jcm9093028. [PMID: 32962242 PMCID: PMC7565100 DOI: 10.3390/jcm9093028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
Sarcoidosis is a granulomatous disorder of unknown etiology characterized by noncaseating granulomas virtually in every organ and tissue. This finding represents the most important diagnostic clue to reach a correct definition of sarcoidosis, although the biopsy is invasive and has several risk procedures. Several efforts are made to suspect the diagnosis of sarcoidosis by combining noninvasive elements, in particular from imaging, though these findings are often nonspecific and reflect the wide multifactorial pathogenesis. Every effort should be made to obtain a detailed radiological picture that, if associated with a suggestive clinical picture, could avoid the need of biopsy in some specific cases. In this narrative review, we aim to describe main computed tomography (CT) features of pulmonary and abdominal sarcoidosis, by reporting strengths and limits of this technique, in particular for the identification of extrapulmonary, isolated disease.
Collapse
Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, “G. Bernabeo” Hospital, Contrada S. Liberata, 66026 Ortona (CH), Italy
- Correspondence: ; Tel./Fax: +39-085-9172287
| | - Iginio Donatiello
- Internal Medicine Unit, University Hospital of Salerno, 84131 Salerno, Italy;
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, “G.d’Annunzio” University, 66100 Chieti, Italy;
| | | | | | - Francesco Cipollone
- Medical Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio”, University of Chieti, 66100 Chieti, Italy;
| | - Maria Adele Giamberardino
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, 66100 Chieti, Italy;
| |
Collapse
|
4
|
Bhattarai B, Mandal A, Lamichhane J, Datar P, Mukhtar O, Alhafidh O, Lixon A, Gayam V, Enriquez D, Quist J, Schmidt F. A symptomatic gastric sarcoidosis and asymptomatic pulmonary sarcoidosis: a rare manifestation. J Community Hosp Intern Med Perspect 2019; 9:440-442. [PMID: 31723393 PMCID: PMC6830201 DOI: 10.1080/20009666.2019.1653140] [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: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of unknown etiology which may present with systemic manifestations. The diagnosis of gastric sarcoidosis needs much effort to accomplish as it is exceedingly rare, and the treatment is usually recommended exclusively for symptomatic disease. Here, we present a case of gastric sarcoidosis in a 31-year old black female patient with symptoms of nausea and epigastric pain. A diagnosis of gastric sarcoidosis was mainly based on the presence of non-necrotizing granulomas on biopsy following esophagogastroduodenoscopy (EGD). She was treated with steroid with high dose at first, followed by a slow taper and the symptoms responded to the treatment.
Collapse
Affiliation(s)
- Bikash Bhattarai
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Amrendra Mandal
- Department of Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Jenny Lamichhane
- Department of Medicine, St. John’s Riverside hospital, Yonkers, NY, USA
| | - Praveen Datar
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Osama Mukhtar
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Oday Alhafidh
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Anton Lixon
- Department of Pulmonary and sleep Medicine, NYU Winthrop, Mineola, NY, USA
| | - Vijay Gayam
- Department of Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Danilo Enriquez
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Joseph Quist
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Frances Schmidt
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| |
Collapse
|
5
|
Arfaoui H, Jabri H, Elkhattabi W, Afif H. [Gastric sarcoidosis revealed by thoracic sarcoidosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:260-263. [PMID: 29748065 DOI: 10.1016/j.pneumo.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Affiliation(s)
- H Arfaoui
- Service de pneumologie, hôpital 20-août, 6, rue Lahssen-Elaarjoun, 20250 Casablanca, Maroc.
| | - H Jabri
- Service de pneumologie, hôpital 20-août, 6, rue Lahssen-Elaarjoun, 20250 Casablanca, Maroc
| | - W Elkhattabi
- Service de pneumologie, hôpital 20-août, 6, rue Lahssen-Elaarjoun, 20250 Casablanca, Maroc
| | - H Afif
- Service de pneumologie, hôpital 20-août, 6, rue Lahssen-Elaarjoun, 20250 Casablanca, Maroc
| |
Collapse
|
6
|
Isolated Gastrointestinal Sarcoidosis Involving Multiple Gastrointestinal Sites Presenting as Chronic Diarrhea. ACG Case Rep J 2016; 3:e198. [PMID: 28119949 PMCID: PMC5226203 DOI: 10.14309/crj.2016.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is a chronic and systemic disorder characterized by the formation of non-caseating granulomas. Very few cases of isolated gastrointestinal sarcoidosis have been reported, and even fewer, if any, report gastrointestinal sarcoidosis within multiple gastrointestinal sites concomitantly. We present a 42-year-old white man with chronic diarrhea and abdominal pain for more than 3 years. Mucosal biopsies revealed non-caseating microgranulomas in the stomach, throughout the small intestine, colon, and rectum. Prednisone therapy was initiated with a rapid improvement in symptoms and complete resolution of diarrhea within 3 weeks.
Collapse
|
7
|
Gezer NS, Başara I, Altay C, Harman M, Rocher L, Karabulut N, Seçil M. Abdominal sarcoidosis: cross-sectional imaging findings. Diagn Interv Radiol 2016; 21:111-7. [PMID: 25512071 DOI: 10.5152/dir.2014.14210] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%-70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis.
Collapse
Affiliation(s)
- Naciye Sinem Gezer
- Department of Radiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | | | | | | | | | | | | |
Collapse
|
8
|
Ultrasonography and Computed Tomographic Manifestations of Abdominal Sarcoidosis in Children. J Pediatr Gastroenterol Nutr 2016; 63:195-9. [PMID: 26913758 DOI: 10.1097/mpg.0000000000001175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Sarcoidosis is a multisystem, granulomatous inflammatory disease affecting both pediatric and adult patients. So far in children, very few radiological descriptions of abdominal sarcoidosis manifestations have been reported. The present study describes the frequency and the appearance of abdominal radiologic manifestations in pediatric patients with histologically proven sarcoidosis. METHODS We reviewed retrospectively all of the radiological examinations of 22 patients ages 1 to 15 years at diagnosis with proven sarcoidosis evaluated in a university pediatric hospital between 1994 and 2014. The locations of biopsies and the angiotensin-converting enzyme level were reported. The size, shape, and parenchymal homogeneity of the liver and spleen, the presence of abdominal lymph nodes, and abnormalities of the gastrointestinal tract were tabulated. RESULTS The study included 22 children (mean age: 9.9 ± 2.8 years). The liver was the most frequent location of biopsy (12/22), even without radiological involvement. Abdominal manifestations were present in 11 of 22 children with sarcoidosis. Hepatomegaly was the most frequent abnormality, reported in 8 of 11 cases either homogeneous (n = 7) or nodular (n = 1). Homogeneous lymph node enlargement was noted in 6 of 11 cases and splenomegaly in 4 of 11 cases. No calcification was observed. All patients with initial abdominal sarcoidosis had simultaneous thoracic involvement. CONCLUSIONS Abdominal manifestations in children sarcoidosis are frequent but often nonspecific. Nodular hepatosplenomegaly is rare. All of our patients with abdominal abnormalities had a more specific associated thoracic involvement. Awareness of this association could assist the clinicians in assessing the initial diagnosis of abdominal sarcoidosis in children.
Collapse
|
9
|
Ghrenassia E, Mekinian A, Chapelon-Albric C, Levy P, Cosnes J, Sève P, Lefèvre G, Dhôte R, Launay D, Prendki V, Morell-Dubois S, Sadoun D, Mehdaoui A, Soussan M, Bourrier A, Ricard L, Benamouzig R, Valeyre D, Fain O. Digestive-tract sarcoidosis: French nationwide case-control study of 25 cases. Medicine (Baltimore) 2016; 95:e4279. [PMID: 27442665 PMCID: PMC5265782 DOI: 10.1097/md.0000000000004279] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 12/21/2022] Open
Abstract
Digestive tract sarcoidosis (DTS) is rare and case-series are lacking. In this retrospective case-control study, we aimed to compare the characteristics, outcome, and treatment of patients with DTS, nondigestive tract sarcoidosis (NDTS), and Crohn disease.We included cases of confirmed sarcoidosis, symptomatic digestive tract involvement, and noncaseating granuloma in any digestive tract. Each case was compared with 2 controls with sarcoidoisis without digestive tract involvement and 4 with Crohn disease.We compared 25 cases of DTS to 50 controls with NDTS and 100 controls with Crohn disease. The major digestive clinical features were abdominal pain (56%), weight loss (52%), nausea/vomiting (48%), diarrhea (32%), and digestive bleeding (28%). On endoscopy of DTS, macroscopic lesions were observed in the esophagus (9%), stomach (78%), duodenum (9%), colon, (25%) and rectum (19%). As compared with NDTS, DTS was associated with weight loss (odds ratio [OR] 5.8; 95% confidence interval [CI] 1.44-23.3) and the absence of thoracic adenopathy (OR 5.0; 95% CI 1.03-25). As compared with Crohn disease, DTS was associated with Afro-Caribbean origin (OR 27; 95% CI 3.6-204) and the absence of ileum or colon macroscopic lesions (OR 62.5; 95% CI 10.3-500). On the last follow-up, patients with DTS showed no need for surgery (versus 31% for patients with Crohn disease; P = 0.0013), and clinical digestive remission was frequent (76% vs. 35% for patients with Crohn disease; P = 0.0002).The differential diagnosis with Crohn disease could be an issue with DTS. Nevertheless, the 2 diseases often have different clinical presentation and outcome.
Collapse
Affiliation(s)
- Etienne Ghrenassia
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Arsene Mekinian
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Catherine Chapelon-Albric
- APHP, Hôpital Pitié-Salpétrière, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne
| | - Pierre Levy
- APHP, Hôpital Tenon, Sorbonne Universités, UPMC Université Paris 06, Public health department
| | - Jacques Cosnes
- APHP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de gastro-entérologie, Paris
| | - Pascal Sève
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, department of internal medicine, F-Lyon. University Claude Bernard Lyon 1, F-69100, Villeurbanne
| | | | - Robin Dhôte
- APHP, Hôpital Avicenne, service de médecine interne, université Paris 13, Bobigny, France
| | - David Launay
- Hôpital Claude Huriez, service de médecine interne, Lille, France
| | - Virginie Prendki
- Department of internal medicine, Division of internal medicine and rehabilitation, rehabilitation and geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Danielle Sadoun
- APHP, Hôpital Avicenne, Université Paris 13, service de pneumologie, Bobigny
| | | | - Michael Soussan
- APHP, Hôpital Avicenne, Université Paris 13, service de médecine nucléaire
| | - Anne Bourrier
- APHP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de gastro-entérologie, Paris
| | - Laure Ricard
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Robert Benamouzig
- APHP, Hôpital Avicenne, Université Paris 13, service de gastro-entérologie, Bobigny, France
| | - Dominique Valeyre
- APHP, Hôpital Avicenne, Université Paris 13, service de pneumologie, Bobigny
| | - Olivier Fain
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| |
Collapse
|
10
|
Ceylan E, Şen S, Coşkun A, Meteoğlu İ, Demirtaş N, Çildağ O. Gastric involvement of sarcoidosis in a patient with multiple lung nodules. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:525-8. [PMID: 26487882 PMCID: PMC4590208 DOI: 10.4103/1735-1995.163981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Sarcoidosis is a granulomatous disorder mostly could involve intrathoracic structures. The gastric involvement is rare and the symptoms may be non-specific. We herein report a case of a 56-year-old female patient who was admitted due to chest tightness and discomfort. Computed tomography (CT) of the thorax revealed bilaterally nodular lesions in the lower lobes of the lung and pleural effusion on the left side. Positron emission tomography/CT showed lung nodules and gastric involvement with mesenteric lymphadenomegalies with pathological uptake of 18F-fluoro-2-deoxy-d-glucose. Pathological examination of the lung biopsy taken by thoracotomy demonstrated non-caseating granulomas. The gastric biopsies taken by endoscopy also showed non-caseating granulomas consistent with a diagnosis of sarcoidosis.
Collapse
Affiliation(s)
- Emel Ceylan
- Department of Pulmonary Medicine, Adnan Menderes University, Aydin, Turkey
| | - Serdar Şen
- Department of Thoracic Surgery, Adnan Menderes University, Aydin, Turkey
| | - Adil Coşkun
- Department of Gastroenterology, Adnan Menderes University, Aydin, Turkey
| | - İbrahim Meteoğlu
- Department of Pathology, Adnan Menderes University, Aydin, Turkey
| | - Nimet Demirtaş
- Department of Pulmonary Medicine, Atatürk State Hospital, Aydin, Turkey
| | - Orhan Çildağ
- Department of Pulmonary Medicine, Adnan Menderes University, Aydin, Turkey
| |
Collapse
|
11
|
|
12
|
Ejeil AL, Thomas A, Mercier S, Moreau N. Unusual gingival swelling in a 4-year-old child. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:627-31. [PMID: 25220780 DOI: 10.1016/j.oooo.2014.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/21/2014] [Accepted: 05/30/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Anne-Laure Ejeil
- Bretonneau Hospital, Department of Oral Surgery, Paris, France, and Paris Descartes University, Sorbonne Paris Cité, France.
| | - Aude Thomas
- Bretonneau Hospital, Department of Oral Surgery, Paris, France, and Paris Descartes University, Sorbonne Paris Cité, France
| | - Sébastien Mercier
- Bretonneau Hospital, Department of Oral Surgery, Paris, France, and Paris Descartes University, Sorbonne Paris Cité, France
| | - Nathan Moreau
- Bretonneau Hospital, Department of Oral Surgery, Paris, France, and Paris Descartes University, Sorbonne Paris Cité, France
| |
Collapse
|
13
|
Eklund A, du Bois RM. Approaches to the treatment of some of the troublesome manifestations of sarcoidosis. J Intern Med 2014; 275:335-49. [PMID: 24433397 DOI: 10.1111/joim.12198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcoidosis can be a major therapeutic challenge given its multiplicity of clinical presentations, variable combination of organ involvement and severity, and unpredictable longitudinal behaviour. Six manifestations of sarcoidosis are especially difficult to manage because of (i) an incomplete knowledge of causation - fatigue and small fibre neuropathy, (ii) the rare occurrence in sarcoidosis - intra-abdominal complications or (iii) the potentially life-threatening consequences in some patients - neurological disease, pulmonary hypertension and hypercalcaemia. In none of these situations have a prospective, double-blind, placebo-controlled trial of any therapy been conducted. Despite this absence of any firm evidence base to support therapeutic recommendations, these six entities can be extremely problematic for the practising clinician. It is for this reason that we have focused in this review on these six disease manifestations and provided a synopsis of each problem together with suggested treatment approaches, based on an analysis of the current literature.
Collapse
Affiliation(s)
- A Eklund
- Department of Medicine, Karolinska University Hospital, Karolinska Institutet and Centre for Molecular Medicine, Stockholm, Sweden
| | | |
Collapse
|
14
|
Abstract
Alterations of the stomach mucosa in response to different adverse effects result in various morphological and clinical symptoms. Gastric mucosa alterations can be classified on the bases of diverse viewpoints. It makes this overview difficult, that identical toxic effects may cause different mucosal changes and different toxic agents may produce similar mucosal appearance. The more accurate understanding of the pathological processes which develop in the stomach mucosa needs reconsideration. The authors make an attempt to define gastritis and gastropathy in order to classify and present their features. Gastritis is a histological definition indicating mucosal inflammation. Acute gastritis is caused by infections. The two most important forms of chronic gastritis are metaplastic atrophic gastritis with an autoimmune origin and Helicobacter pylori inflammation. Gastropathy is the name of different structural alterations of the mucosa. Its most important feature is the paucity of inflammatory signs. Gastropathies can be divided into 4 categories based on the nature of the underlying pathological effect, on its morphological appearance and the way of the development. Differential diagnosis is an important pathological and clinical task because different treatment methods and prognosis.
Collapse
Affiliation(s)
- Emese Mihály
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Tamás Micsik
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Patológiai és Kísérleti Rákkutató Intézet Budapest
| | - Márk Juhász
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - László Herszényi
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Zsolt Tulassay
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088 Semmelweis Egyetem, Általános Orvostudományi Kar MTA-SE Molekuláris Medicina Kutatócsoport Budapest
| |
Collapse
|
15
|
Gastric sarcoidosis in children: A case report and review of the literature. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2013. [DOI: 10.1016/j.ejmhg.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
16
|
Mankodi S, Planche K, Watkins J, Murray C. Malignant mimicry--a 17-year-old with abdominal pain and weight loss. Gut 2013; 62:995, 1084. [PMID: 22914297 DOI: 10.1136/gutjnl-2012-303358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- Sheena Mankodi
- Department of Gastroenterology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
| | | | | | | |
Collapse
|
17
|
Ungprasert P, Kue-A-Pai P, Srivali N, Cheungpasitporn W, Griger DT. A rare case of symptomatic gastric sarcoidosis. QJM 2013; 106:569-70. [PMID: 23483139 DOI: 10.1093/qjmed/hct067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Ungprasert
- Department of Internal Medicine, 202-251-5057 Bassett Medical Center, 1 Atwell Road, Cooperstown, NY 13326, USA.
| | | | | | | | | |
Collapse
|
18
|
Vadlamudi NB, Navaneethan U, Thame KA, Kelly DR, Dimmitt RA, Harris WT. Crohn's disease with pulmonary manifestations in children: 2 case reports and review of the literature. J Crohns Colitis 2013; 7:e85-92. [PMID: 22704660 DOI: 10.1016/j.crohns.2012.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/07/2012] [Accepted: 05/08/2012] [Indexed: 02/07/2023]
Abstract
Crohn's disease (CD) is a chronic granulomatous disease of unknown etiology that affects primarily the gastrointestinal system but can be associated with extraintestinal manifestations. Latent pulmonary involvement in children with CD has been described, but symptomatic pulmonary disease has rarely been reported in children. In this review, we report two pediatric cases, one with pleural effusion at the time of CD diagnosis and the other with bilateral cavitary lesions in a previously diagnosed CD patient. We review the current literature and summarize the diagnosis and management of pulmonary involvement in CD. Awareness of these pulmonary complications of CD in children may lead to more prompt diagnosis, guide appropriate therapy, and decrease morbidity.
Collapse
Affiliation(s)
- Narendra B Vadlamudi
- Division of Pediatric Gastroenterology and Nutrition, Children's of Alabama, Birmingham, AL 35233, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Rochoy M, Lefèvre G, Fontaine A, Boualit M, Le Roy P, Neugebauer Y, Chanson N, Le Gouellec N, Launay D, Lambert M, Hachulla E, Hatron PY. [Atypical gastritis]. Rev Med Interne 2013; 34:581-2. [PMID: 23478158 DOI: 10.1016/j.revmed.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/07/2013] [Accepted: 02/04/2013] [Indexed: 11/25/2022]
Affiliation(s)
- M Rochoy
- Service de médecine interne, centre de référence pour les maladies auto-immunes et systémiques rares (sclérodermie systémique), CHRU de Lille, université Lille Nord-de-France, 59037 Lille, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Esophageal sarcoidosis: a review of cases and an update. ISRN GASTROENTEROLOGY 2013; 2013:836203. [PMID: 23533794 PMCID: PMC3603204 DOI: 10.1155/2013/836203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/30/2013] [Indexed: 12/19/2022]
Abstract
Sarcoidosis is a chronic disorder that can virtually affect any organ system in the body. Histologically, it is characterized by the presence of T lymphocytes, mononuclear phagocytes, and noncaseating granulomas. Most commonly affected are the intrathoracic structures, with 90% of the reported cases involving the lungs. Esophageal involvement in sarcoidosis is extremely rare. Dysphagia is the most common presentation in these patients and can be attributed to various mechanisms such as direct esophageal wall infiltration, extrinsic compression, cranial neuropathy, and brainstem involvement. A thorough online literature review revealed only 23 reported cases of esophageal involvement in sarcoidosis. This paper reviews these reported cases in detail along with newer diagnostic and treatment options, including direction of future therapy.
Collapse
|
21
|
Demongeot C, Moulonguet I, Georges P, Bagot M, Flageul B. Sarcoïdose gastrique révélée par une sarcoïdose cutanée folliculaire. Ann Dermatol Venereol 2011; 138:116-9. [DOI: 10.1016/j.annder.2010.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 09/07/2010] [Accepted: 10/18/2010] [Indexed: 11/26/2022]
|
22
|
Abstract
Sarcoidosis is an inflammatory disease characterized by non-caseating granulomas in the absence of other autoimmune processes, infectious diseases, or foreign agents. The etiology of sarcoidosis is not completely understood. Several organ systems can be affected, of which the most frequently involved include the lungs and lymph nodes. Intra-abdominal sarcoidosis is less common, but can be found in the absence of pulmonary or lymphatic disease. Intra-abdominal sarcoidosis is most often asymptomatic. However, long-standing unrecognized disease can result in life-threatening complications. The identification, monitoring and prevention of these complications will be discussed, with emphasis on both clinical and histological presentations of intra-abdominal sarcoidosis.
Collapse
|
23
|
|
24
|
Maàmouri N, Guellouz S, Ben Hariz F, Ketari S, Belkahla N, Ouerghi H, Chelly-Enneifer I, Chouaib S, Moncef Zitouna M, Ben Mami N. [Gastrointestinal sarcoidosis]. Rev Med Interne 2010; 31:262-7. [PMID: 20170990 DOI: 10.1016/j.revmed.2009.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 09/23/2009] [Accepted: 12/18/2009] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sarcoidosis is a granulomatous disorder of unknown cause, characterised by noncaseating granulomas affecting multiple organs. Gastrointestinal tract involvement in sarcoidosis is rare. The stomach, particularly the antrum is the most common extra-hepatic organ to be involved. We report four cases of gastro-intestinal sarcoidosis. METHODS Retrospective study of a series of four cases. RESULTS All patients had gastric sarcoidosis. It involved the duodenum, ileum and gall bladder in a patient with a history of an acute pancreatitis probably due to sarcoidosis. This patient presented with obstructive intestinal manifestations, weight loss and exsudative enteropathy. Two patients presented with mild abdominal pain and the last patient was admitted for upper gastrointestinal bleeding. The endoscopy was normal in one case and showed an antral congestion in another case. Gastric ulcers were found in the patient with a history of upper gastro-intestinal bleeding. A pseudo-linitic aspect was noticed in the patient with obstructive manifestations. The duodenum and the ileum were normal. This patient had an antrectomy and was treated with corticosteroids. Surgery evidenced a perforated duodenal ulcer, which was obstructed by the gall bladder. The patient with gastrointestinal bleeding received proton pump inhibitor and corticosteroids. These two patients improved gradually. The two other patients recovered spontaneously. CONCLUSION The stomach is the most commonly affected organ in gastrointestinal sarcoidosis. Gastric sarcoidosis can mimic a malignant lesion owing to narrowing of the gastric lumen or can be revealed by upper gastrointestinal bleeding. Duodenum, small bowel and colon involvement is uncommon but may be underestimated in the absence of systematic biopsies.
Collapse
Affiliation(s)
- N Maàmouri
- Service de gastro-entérologie B, hôpital La Rabta, 1007 Tunis Jebbari, Tunisie
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Ahmed HM, Liang DB, Giday SA, Montgomery EA, Farmer NM. Necrotizing sarcoid granulomatosis: a case report of gastric involvement. J Hosp Med 2010; 5:113-4. [PMID: 20104629 DOI: 10.1002/jhm.499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Haitham M Ahmed
- Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
| | | | | | | | | |
Collapse
|