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Nadpara N, Greenwald HS, Parkman HP. Treatment of a Gastrointestinal Sarcoidosis Flare: A Multidisciplinary Approach for a Multisystem Disease. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932494. [PMID: 34552042 PMCID: PMC8477980 DOI: 10.12659/ajcr.932494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient: Female, 68-year-old
Final Diagnosis: Sarcoidosis
Symptoms: Dysphagia • epigastric pain • nausea • vomiting
Medication: —
Clinical Procedure: —
Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Neil Nadpara
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Holly S Greenwald
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Henry P Parkman
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Papiris SA, Georgakopoulos A, Papaioannou AI, Pianou N, Kallergi M, Kelekis NL, Gialafos H, Manali ED, Chatziioannou S. Emerging phenotypes of sarcoidosis based on 18F-FDG PET/CT: a hierarchical cluster analysis. Expert Rev Respir Med 2019; 14:229-238. [PMID: 31647341 DOI: 10.1080/17476348.2020.1684902] [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: 02/07/2023]
Abstract
Objectives: In sarcoidosis, the definition of organ involvement with traditional means appears laborious and somewhat controversial, and phenotyping by the above overlapping. 18F-FDG PET/CT defines disease extent by activity more precisely, and may result in a better understanding of sarcoidosis disease behavior and phenotypes expression. We hypothesized that 18F-FDG PET/CT could add in the phenotyping of sarcoidosis patients by unveiling in detail sites of involvement even in clinically and physiologically silent disease.Methods: This study was designed to investigate the role of 18F-FDG PET/CT in phenotyping sarcoidosis using cluster analysis by adding this new means in the routine work-up of 195 sarcoidosis patients of a single academic center.Results: 18F-FDG PET/CT succeeded to identify despite the random distribution of the disease, an ordered stratification into 4 phenotypes: I) thoracic nodal hilar-mediastinal, II) thoracic nodal hilar-mediastinal and lungs, III) an extended thoracic and extra-thoracic only nodal phenotype including inguinal-abdominal-supraclavicular stations, and IV) all the above plus systemic organs and tissues such as muscles-bones-spleen and skin.Conclusion: Though further studies are necessary to confirm findings as patterns of disease behavior; the proposed phenotypes may prove useful in the design of future studies with homogeneous cohorts facilitating in sarcoidosis patients a personalized medicine approach.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Georgakopoulos
- Nuclear Medicine Division, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Pianou
- Nuclear Medicine Division, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece
| | - Maria Kallergi
- Nuclear Medicine Division, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece
| | - Nikolaos L Kelekis
- 2nd Department of Radiology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helias Gialafos
- Aiginitio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Chatziioannou
- Nuclear Medicine Division, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece.,2nd Department of Radiology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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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.
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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)
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