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Campani C, Guido M, Marra F. Elusive Hepatic Nodules. Gastroenterology 2024; 167:660-663. [PMID: 38527591 DOI: 10.1053/j.gastro.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Guido
- Department of Medicine, University of Padua, Padua, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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2
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Hirt PA, Gonzalez AM, Acosta AS, Price A, Elgart GW, Nousari CH, George M, Schachner LA. Cutaneous Mycobacterium avium-intracellulare infection masquerading as sarcoidosis. Pediatr Dermatol 2024; 41:497-500. [PMID: 38173086 DOI: 10.1111/pde.15491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
Mycobacterium avium-intracellulare (MAC) infection may have different skin manifestations, including cutaneous granulomas. Granulomatous skin reactions have distinct morphologic and histopathologic appearances. We present the case of an adolescent male with cutaneous MAC, misdiagnosed as sarcoidosis after initial biopsy results, demonstrated preservation of reticulin fibers and absence of organisms within granulomas. Sarcoidal granulomas often stain positive for reticulin fibers, which could be used to distinguish them from the infectious kind. This case should alert clinicians to the fact that the presence or quantity of intact reticular fibers may not be a reliable tool to differentiate between a sarcoidal and an infectious granuloma. Our case also highlights the diagnostic challenge of cutaneous MAC infection.
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Affiliation(s)
- Penelope A Hirt
- Department of Dermatology, Larkin Community Hospital, South Miami, Florida, USA
| | - Adrianna M Gonzalez
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ana S Acosta
- Florida Academic Dermatology Center, Coral Gables, Florida, USA
| | - Alexandra Price
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - George W Elgart
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Carlos H Nousari
- Department of Dermatology, Institute for Immunofluorescence, Dermpath Diagnostics South Florida, Pompano Beach, Florida, USA
| | - Manju George
- Pediatric Dermatology of the Palm Beaches, Palm Beach Gardens, Florida, USA
| | - Lawrence A Schachner
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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3
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Weeratunga P, Moller DR, Ho LP. Immune mechanisms of granuloma formation in sarcoidosis and tuberculosis. J Clin Invest 2024; 134:e175264. [PMID: 38165044 PMCID: PMC10760966 DOI: 10.1172/jci175264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Sarcoidosis is a complex immune-mediated disease characterized by clusters of immune cells called granulomas. Despite major steps in understanding the cause of this disease, many questions remain. In this Review, we perform a mechanistic interrogation of the immune activities that contribute to granuloma formation in sarcoidosis and compare these processes with its closest mimic, tuberculosis, highlighting shared and divergent immune activities. We examine how Mycobacterium tuberculosis is sensed by the immune system; how the granuloma is initiated, formed, and perpetuated in tuberculosis compared with sarcoidosis; and the role of major innate and adaptive immune cells in shaping these processes. Finally, we draw these findings together around several recent high-resolution studies of the granuloma in situ that utilized the latest advances in single-cell technology combined with spatial methods to analyze plausible disease mechanisms. We conclude with an overall view of granuloma formation in sarcoidosis.
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Affiliation(s)
- Praveen Weeratunga
- MRC Translational Immunology Discovery Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Ling-Pei Ho
- MRC Translational Immunology Discovery Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
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4
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Hodzhev Y, Tsafarova B, Tolchkov V, Youroukova V, Ivanova S, Kostadinov D, Yanev N, Zhelyazkova M, Tsonev S, Kalfin R, Panaiotov S. Visualization of the individual blood microbiome to study the etiology of sarcoidosis. Comput Struct Biotechnol J 2023; 22:50-57. [PMID: 37928975 PMCID: PMC10624578 DOI: 10.1016/j.csbj.2023.10.027] [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: 06/19/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Single microbial pathogens or host-microbiome dysbiosis are the causes of lung diseases with suspected infectious etiology. Metagenome sequencing provides an overview of the microbiome content. Due to the rarity of most granulomatous lung diseases collecting large systematic datasets is challenging. Thus, single-patient data often can only be summarized visually. Objective To increase the information gain from a single-case metagenome analysis we suggest a quantitative and qualitative approach. Results The 16S metagenomic results of 7 patients with pulmonary sarcoidosis were compared with those of 22 healthy individuals. From lysed blood, total microbial DNA was extracted and sequenced. Cleaned data reads were identified taxonomically using Kraken 2 software. Individual metagenomic data were visualized with a Sankey diagram, Krona chart, and a heat-map. We identified five genera that were exclusively present or significantly enhanced in patients with sarcoidosis - Veillonella, Prevotella, Cutibacterium, Corynebacterium, and Streptococcus. Conclusions Our approach can characterize the blood microbiome composition and diversity in rare diseases at an individual level. Investigation of the blood microbiome in patients with granulomatous lung diseases of unknown etiology, such as sarcoidosis could enhance our comprehension of their origin and pathogenesis and potentially uncover novel personalized therapeutics.
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Affiliation(s)
- Yordan Hodzhev
- Microbiology Department, National Center of Infectious and Parasitic Diseases, Yanko Sakazov 26 Blvd., Sofia 1504, Bulgaria
| | - Borislava Tsafarova
- Microbiology Department, National Center of Infectious and Parasitic Diseases, Yanko Sakazov 26 Blvd., Sofia 1504, Bulgaria
| | - Vladimir Tolchkov
- Microbiology Department, National Center of Infectious and Parasitic Diseases, Yanko Sakazov 26 Blvd., Sofia 1504, Bulgaria
| | - Vania Youroukova
- Department of Pulmonary Diseases, University Hospital for Pulmonary Diseases “St. Sofia”, Medical University of Sofia, Akad. Ivan Evstratiev Geshov 17 Blvd., Sofia 1431, Bulgaria
| | - Silvia Ivanova
- Department of Pulmonary Diseases, University Hospital for Pulmonary Diseases “St. Sofia”, Medical University of Sofia, Akad. Ivan Evstratiev Geshov 17 Blvd., Sofia 1431, Bulgaria
| | - Dimitar Kostadinov
- Department of Pulmonary Diseases, University Hospital for Pulmonary Diseases “St. Sofia”, Medical University of Sofia, Akad. Ivan Evstratiev Geshov 17 Blvd., Sofia 1431, Bulgaria
| | - Nikolay Yanev
- Department of Pulmonary Diseases, University Hospital for Pulmonary Diseases “St. Sofia”, Medical University of Sofia, Akad. Ivan Evstratiev Geshov 17 Blvd., Sofia 1431, Bulgaria
| | - Maya Zhelyazkova
- Faculti of Mathematics and Informatics, Sofia University St. Kliment Ohridski, 5 James Bourchier Blvd., 1164 Sofia, Bulgaria
| | - Stefan Tsonev
- Agrobioinstitute (ABI), 8 Dragan Tsankov, Blvd, Sofia 1164, Bulgaria
| | - Reni Kalfin
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria
- Department of Health Care, South-West University “Neofit Rilski”, Blagoevgrad 2700, Bulgaria
| | - Stefan Panaiotov
- Microbiology Department, National Center of Infectious and Parasitic Diseases, Yanko Sakazov 26 Blvd., Sofia 1504, Bulgaria
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Müller ML, Poller W, Skurk C, Poddubnyy D, Siegmund B, Schneider T, Landmesser U, Heidecker B. Cardiac sarcoidosis presenting with complex conduction abnormalities as the first manifestation of widespread systemic sarcoidosis: a case report. Eur Heart J Case Rep 2023; 7:ytad017. [PMID: 36733684 PMCID: PMC9887667 DOI: 10.1093/ehjcr/ytad017] [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: 05/30/2022] [Revised: 08/11/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Background Sarcoidosis is a granulomatous multi-organ disease of unknown aetiology. Despite being relatively rare, cardiac sarcoidosis constitutes a very important manifestation of sarcoidosis, as its symptoms regularly precede or occur in isolation of more prevalent ones, and as it is the main driver of mortality in systemic sarcoidosis. Case summary We present the case of a 37-year-old woman, in which clinically isolated cardiac sarcoidosis revealed widespread systemic sarcoidosis. Apart from constitutional symptoms and strong recurrent dizziness (i.e. near-syncopes), which persisted for multiple years already, our patient initially presented with complex conduction abnormalities, including a right bundle branch block, left anterior hemi-block, and atrioventricular block °1. Following inconclusive endomyocardial biopsies, performed due to detection of focal septal scarring on cardiac magnetic resonance imaging, an 18F-FDG-PET-CT, performed upon admission to our clinic, showed distinct hypermetabolic lesions indicative of active inflammation in various organs and raised suspicion of systemic sarcoidosis. Eventually, histopathological evidence of non-caseating granulomas in affected lymph nodes, extracted by bronchoscopy, confirmed the diagnosis of systemic sarcoidosis after reasonable exclusion of other granulomatous diseases. Immediate initiation of long-term immunosuppressive therapy led to almost complete remission, as monitored by consequential 18F-FDG-PET-CT scans. Discussion Unexplained complex conduction abnormalities in young patients may be a sign of sarcoidosis, even in isolation of more prevalent symptoms. Correct interpretation and prompt initiation of a structured interdisciplinary diagnostic workup, including 18F-FDG-PET-CT as the imaging modality of choice, are essential to initiate specific treatment and obviate the major risk of mortality resulting from cardiac sarcoidosis.
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Affiliation(s)
- Maximilian L Müller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Thomas Schneider
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Bettina Heidecker
- Corresponding author. Tel: +49 30 450 513 756, Fax: +49 30 450 7 513 984,
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Hansdah R, Kushwaha A, Saxena SK, Jinkala S, Alexander A. An Unusual Tumor in an Uncommon Site-Orbital Rosai-Dorfman Disease: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:5584-5587. [PMID: 36742722 PMCID: PMC9895672 DOI: 10.1007/s12070-021-02908-y] [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: 07/29/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
Rosai-Dorfman disease (RDD) is also known as Sinus Histiocytosis with Massive Lymphadenopathy. It is a rare, benign, self-limiting disease of phagocytic histiocytes presenting with massive painless cervical lymphadenopathy. RDD can present as a nodal disease and also extra-nodal involvement with episodes of exacerbation and remissions and relapses after treatment. Its etiology remains poorly understood and is highly variable in its clinical presentation and response to treatment. Its treatment is poorly defined but the prognosis is usually fair. Here we are reporting a rare, unusual clinical presentation of infraorbital soft tissue mass diagnosed as RDD with cyto-histopathological correlation. Only a few such cases have been reported in the literature.
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Affiliation(s)
- Rashmi Hansdah
- Present Address: Department of Otorhinolaryngology, JIPMER, Puducherry, 605006 India
| | - Akshat Kushwaha
- Present Address: Department of Otorhinolaryngology, JIPMER, Puducherry, 605006 India
| | - Sunil Kumar Saxena
- Present Address: Department of Otorhinolaryngology, JIPMER, Puducherry, 605006 India
| | | | - Arun Alexander
- Present Address: Department of Otorhinolaryngology, JIPMER, Puducherry, 605006 India
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Hacıosmanoğlu T, Türk S, Baloğlu İH, Yavuzsan E, Yavuzsan AH. Sarcoidosis With Bilateral Testicular Involvement Resembling Testicular Cancer: A Rare Case Report. Cureus 2022; 14:e23982. [PMID: 35547417 PMCID: PMC9090139 DOI: 10.7759/cureus.23982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis is a granulomatous inflammatory disease that could potentially involve multiple organ systems. It causes noncaseating granulomas in tissues, and at least two organs must be involved to make a diagnosis. In sarcoidosis patients, if there is a mass in the testicles, a testicular biopsy should be performed to exclude malignancies because of infrequent testicular involvement. We present a 23-year-old male diagnosed with sarcoidosis who had a bilateral testicular mass. A testicular biopsy was performed because of bilateral involvement. The biopsy revealed a diagnosis of sarcoidosis. After high-dose steroid treatment, the lesions regressed. This paper presents a sarcoidosis case with testicular involvement that imitates testicular tumors. Testicular tumors and testicular involvement of sarcoidosis are two different pathologies that may mimic each other, confuse clinicians, and/or lead to misdiagnosis and mistreatment.
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8
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Pandey A, Stoker T, Adamczyk LA, Stacpoole S. Aseptic meningitis and hydrocephalus secondary to neurosarcoidosis. BMJ Case Rep 2021; 14:14/8/e242312. [PMID: 34446511 PMCID: PMC8395265 DOI: 10.1136/bcr-2021-242312] [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] [Indexed: 11/20/2022] Open
Abstract
A 53-year-old woman presented to hospital with gait instability, urinary incontinence and confusion. She had a 4-month history of headache, blurred vision, personality change and memory problems. Magnetic Resonance Imaging of the brain after contrast application showed tectal plate and occipital enhancement, as well as a known hydrocephalus. Cerebrospinal fluid showed aseptic meningitis with no evidence of clonal expansion. After further imaging that showed generalised lymphadenopathy and subsequent tissue biopsy that showed granulomatous lymphadenitis, she was diagnosed with neurosarcoidosis. She was treated with steroids which resulted in immediate cognitive and motor improvements as well as resolution of her urinary incontinence. We discuss the features of this case that pointed towards neoplastic, infective and other autoimmune aetiologies. We describe how they were excluded and provide the rationale for our treatment. This case demonstrates an important sequela sarcoidosis, and we conclude by recommending a multidisciplinary approach towards its diagnosis and management.
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Affiliation(s)
- Anmol Pandey
- Department of Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Thomas Stoker
- Department of Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lukasz A Adamczyk
- Department of Histopathology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Sybil Stacpoole
- Department of Neurology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
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9
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Low QJ, Misni MNB, Cheo SW, Ng KL, Muhammad NA. A case of chronic cough due to sarcoidosis. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211019053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sarcoidosis is a multisystemic, chronic granulomatous disease of unknown aetiology that often affects the lungs. Diagnosis and treatment of sarcoidosis can be strenuous. Patients may be asymptomatic or experience cough, dyspnoea, fatigue, unintentional weight loss or night sweats. Computed tomography is valuable in the diagnosis of sarcoidosis. The typical histopathological lesion of sarcoidosis is granuloma without caseous necrosis in the involved organs. As tuberculosis is endemic in our region, clinicians should not forget this great mimicker. The cornerstone of treatment of sarcoidosis is corticosteroids but newer agents such as steroid-sparing agents and biological agents are available. We report a case of pulmonary sarcoidosis presenting with chronic cough.
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Affiliation(s)
- Qin Jian Low
- Department of Internal Medicine, Hospital Sultanah Nora Ismail, Batu Pahat, Malaysia
| | | | - Seng Wee Cheo
- Department of Internal Medicine, Hospital Lahad Datu, Lahad Datu, Malaysia
| | - Khai Lip Ng
- Department of Respiratory Medicine, Hospital Serdang, Kajang, Malaysia
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10
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Abstract
CONTEXT.— Because granulomas are represented in almost every disease category, the number of clinically and pathologically important granulomatous pulmonary diseases is large. Their diagnosis by pathologists is particularly challenging because of their nonspecificity. A specific diagnosis can be achieved only when a granuloma-inciting agent(s) (eg, acid-fast bacilli, fungi, foreign bodies, etc) are identified microscopically or by culture; this does not occur in most cases. Furthermore, a specific diagnosis cannot be reached in a high percentage of cases. Although sarcoidosis and infectious diseases account for approximately half of pulmonary granulomatous diseases worldwide, there is significant geographic variation in their prevalence. OBJECTIVES.— To present updated information to serve as a guide to pathologic diagnosis of pulmonary granulomatous diseases, to address some commonly held misconceptions and to stress the importance of multidisciplinary coordination. Presentation of basic aspects of granulomas is followed by discussion of specific disease entities, such as tuberculous and nontuberculous Mycobacterial infections, fungal, bacterial, and parasitic infections, sarcoidosis, necrotizing sarcoid granulomatosis, berylliosis, hypersensitivity pneumonitis, hot tub lung, rheumatoid nodule, bronchocentric granulomatosis, aspirated, inhaled, and embolized foreign bodies, drug-induced granulomas, chronic granulomatous disease, common variable immunodeficiency, and granulomatous lesions associated with various types of cancer. DATA SOURCES.— Review of pertinent medical literature using the PubMed search engine and the author's practical experience. CONCLUSIONS.— Although the diagnosis of granulomatous lung diseases continues to present significant challenges to pathologists, the information presented in this review can be helpful in overcoming them. The importance of multidisciplinary coordination in cases where morphologic diagnosis is not possible cannot be overstated.
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Affiliation(s)
- Yale Rosen
- From the Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, New York
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Mousapasandi A, Herbert C, Thomas P. Potential use of biomarkers for the clinical evaluation of sarcoidosis. J Investig Med 2021; 69:jim-2020-001659. [PMID: 33452128 DOI: 10.1136/jim-2020-001659] [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] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology and pathogenesis with a heterogeneous clinical presentation. In the appropriate clinical and radiological context and with the exclusion of other diagnoses, the disease is characterized by the pathological presence of non-caseating epithelioid cell granulomas. Sarcoidosis is postulated to be a multifactorial disease caused by chronic antigenic stimulation. The immunopathogenesis of sarcoidosis encompasses a complex interaction between the host, genetic factors and postulated environmental and infectious triggers, which result in granuloma development.The exact pathogenesis of the disease has yet to be elucidated, but some of the inflammatory pathways that play a key role in disease progression and outcomes are becoming apparent, and these may form the logical basis for selecting potential biomarkers.Biomarkers are biological molecules that are altered pathologically. To date, there exists no single reliable biomarker for the evaluation of sarcoidosis, either diagnostically or prognostically but new candidates are emerging. A diagnosis of sarcoidosis ideally requires a biopsy confirming non-caseating granulomas, but the likelihood of progression that requires intervention remains unpredictable. These challenging aspects could be potentially resolved by incorporating biomarkers into clinical practice for both diagnosis and monitoring disease activity.This review outlines the current knowledge on sarcoidosis with an emphasis on pulmonary sarcoidosis, and delineates the understanding surrounding the implication of biomarkers for the clinical evaluation of sarcoidosis.
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Affiliation(s)
- Amir Mousapasandi
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Cristan Herbert
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Paul Thomas
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Prince of Wales' Hospital and Prince of Wales' Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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12
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Thillai M, Atkins CP, Crawshaw A, Hart SP, Ho LP, Kouranos V, Patterson K, Screaton NJ, Whight J, Wells AU. BTS Clinical Statement on pulmonary sarcoidosis. Thorax 2020; 76:4-20. [PMID: 33268456 DOI: 10.1136/thoraxjnl-2019-214348] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Muhunthan Thillai
- Cambridge Interstitial Lung Disease Unit, Royal Papworth Hospital, Cambridge, Cambridgeshire, UK
| | - Christopher P Atkins
- Department of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Anjali Crawshaw
- Interstitial Lung Disease Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Simon P Hart
- Respiratory Research Group, Hull York Medical School/University of Hull, Cottingham, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK.,Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, London, UK
| | - Karen Patterson
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, London, UK
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13
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Singh P, Jain E, Dhingra H, Mohan H, Thami GP. Clinico-pathological spectrum of cutaneous sarcoidosis: an experience from a government institute in North India. Med Pharm Rep 2020; 93:241-245. [PMID: 32832888 PMCID: PMC7418838 DOI: 10.15386/mpr-1384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/05/2019] [Accepted: 01/12/2020] [Indexed: 12/02/2022] Open
Abstract
Background and aims Sarcoidosis is a multisystem granulomatous disease of unknown etiology and cutaneous involvement is the second most frequent manifestation in systemic sarcoidosis. The aim of the present study is to evaluate the clinical and pathological spectrum of cutaneous sarcoidosis and compare the same with literature available. Methods The present retrospective study was conducted from January 2010–March 2015 and fifteen cases diagnosed as cutaneous sarcoidosis on biopsy were reviewed. The histological spectrum of cutaneous sarcoidosis was evaluated. Results The mean age at diagnosis was 46 years. Nine (60%) cases out of 15 were females. Most common cutaneous lesions were nodules (46.6%) followed by papules (40%). Classically, lymphocyte-poor, non-caseating epithelioid cell granulomas, was the most common histologic finding. Inclusion bodies were seen in 20% cases with occasional presence of fibrinoid necrosis (13.3%). Peri-adnexal granuloma, seen in one case, raised the possibility of tuberculoid leprosy. Foreign body was seen in one case supporting the opinion that sarcoidosis and granulomatous foreign body reaction are not mutually exclusive. Epidermal changes including atrophy, loss of rete pegs, acanthosis, papillomatosis, hyperkeratosis, parakeratosis and basal cell vacuolation were seen in 46.6% cases. Reticulin was positive in all the cases while special stains for acid fast bacilli and fungi were negative. Conclusion The clinical presentation of cutaneous sarcoidosis may be variable. Presence of naked, reticulin-rich granulomas is the most characteristic histopathological finding. Correlation of clinical history with histologic examination is essential to exclude other granulomatous diseases including leprosy, syphilis, other infectious granulomatous diseases and foreign body reaction.
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Affiliation(s)
- Priyanka Singh
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | | | - Harshi Dhingra
- Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Harsh Mohan
- Department of Pathology, Government Medical College and Hospital, Sector 32-A, Chandigarh, India
| | - G P Thami
- Department of Pathology, Government Medical College and Hospital, Sector 32-A, Chandigarh, India
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14
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Sarcoidosis: Causes, Diagnosis, Clinical Features, and Treatments. J Clin Med 2020; 9:jcm9041081. [PMID: 32290254 PMCID: PMC7230978 DOI: 10.3390/jcm9041081] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease with nonspecific clinical manifestations that commonly affects the pulmonary system and other organs including the eyes, skin, liver, spleen, and lymph nodes. Sarcoidosis usually presents with persistent dry cough, eye and skin manifestations, weight loss, fatigue, night sweats, and erythema nodosum. Sarcoidosis is not influenced by sex or age, although it is more common in adults (< 50 years) of African-American or Scandinavians decent. Diagnosis can be difficult because of nonspecific symptoms and can only be verified following histopathological examination. Various factors, including infection, genetic predisposition, and environmental factors, are involved in the pathology of sarcoidosis. Exposures to insecticides, herbicides, bioaerosols, and agricultural employment are also associated with an increased risk for sarcoidosis. Due to its unknown etiology, early diagnosis and detection are difficult; however, the advent of advanced technologies, such as endobronchial ultrasound-guided biopsy, high-resolution computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography has improved our ability to reliably diagnose this condition and accurately forecast its prognosis. This review discusses the causes and clinical features of sarcoidosis, and the improvements made in its prognosis, therapeutic management, and the recent discovery of potential biomarkers associated with the diagnostic assay used for sarcoidosis confirmation.
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15
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Buja LM, Ottaviani G, Ilic M, Zhao B, Lelenwa LC, Segura AM, Bai Y, Chen A, Akkanti B, Hussain R, Nathan S, Petrovic M, Radovancevic R, Gregoric ID, Kar B. Clinicopathological manifestations of myocarditis in a heart failure population. Cardiovasc Pathol 2019; 45:107190. [PMID: 31896440 DOI: 10.1016/j.carpath.2019.107190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022] Open
Abstract
Myocarditis continues to present challenges in diagnosis and management. The goal of this study is to determine the occurrence and manifestations of myocarditis in a heart failure (HF) population. The analyzed patients had acute or persistent HF and were referred over a 6-year period to a quaternary HF center for advanced HF therapies including mechanical circulatory support, left ventricular assist device (LVAD) implantation, and/or heart transplantation. The histopathological diagnosis of myocarditis was made based on the presence of an inflammatory infiltrate of the myocardium, typically with associated cardiomyocyte (CMC) damage, combined as indicated with immunohistochemical and molecular biology characterization. The pathological findings were correlated with a panel of clinical parameters and clinical course of the patients. Myocarditis was identified in 36 patients, with initial diagnoses made in 10 (40%) of 25 by endomyocardial biopsy (EMB), 1 by atrial biopsy (maze procedure), 7 (2.1%) of 331 at LVAD implantation, and 18 (7.8%) of 229 in the explanted heart. There were 20 cases of lymphocytic myocarditis, 4 cases of giant cell myocarditis, 3 cases of eosinophilic myocarditis, and 9 cases of lymphohistocytic with granulomas myocarditis - cardiac sarcoidosis. EMB was performed in 25 patients and was positive in 10 (40%) of cases. Myocarditis was found in 23 explanted hearts including 18 cases de novo and 5 cases with a previously positive specimen. Of the 23 explanted hearts, 21 were nonischemic cardiomyopathy and 2 were ischemic cardiomyopathy. Our findings show that, in patients presenting to a quaternary medical center, myocarditis can be manifest as acute HF as well as a complicating factor in chronic HF.
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Affiliation(s)
- Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA.
| | - Giulia Ottaviani
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Milica Ilic
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Laura C Lelenwa
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ana Maria Segura
- Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA
| | - Yu Bai
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Alice Chen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Bindu Akkanti
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Rahat Hussain
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Sriram Nathan
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Marija Petrovic
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Rajko Radovancevic
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Igor D Gregoric
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Biswajit Kar
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
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16
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Diagnosis issues in sarcoidosis. Respir Med Res 2019; 77:37-45. [PMID: 32035337 DOI: 10.1016/j.resmer.2019.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/12/2019] [Accepted: 09/27/2019] [Indexed: 11/23/2022]
Abstract
Multiple problems may be encountered during the diagnosis of sarcoidosis: at first diagnose sarcoidosis in an appropriate clinical setting, secondly, identify any manifestation to be linked to sarcoidosis at diagnosis work-up and during evolution; thirdly, recognize "danger" in sarcoidosis and parasarcoidosis syndromes, and finally, diagnose sarcoidosis recovery. Diagnosis is often delayed as presentation may be diverse, non-specific, or atypical. Diagnosis of sarcoidosis is based on three criteria: a compatible presentation; evidence of non-caseating granulomas and exclusion of any alternative diagnosis. However, even when all criteria are fulfilled, the probability of sarcoidosis diagnosis varies from definite to only possible depending upon the presence of more or less characteristic radio-clinical and histopathological findings and on the epidemiological context. Bilateral hilar lymphadenopathy and/or diffuse lung micronodules mainly along lymphatics are the most frequent highly suggestive findings. Evidence of granulomas relies on superficial biopsies of clinically suspected lesion when present or most often by bronchial endoscopy. The diagnosis of sarcoidosis may be difficult in absence of thoracic or skin manifestations and may require the benefit of hindsight before being definitive. Differential diagnoses, mainly tuberculosis, must be considered. The diagnosis of events during evolution relies on serial clinical, pulmonary function, radiographic evaluation and on extrapulmonary manifestations work-up, including electrocardiogram and blood biology. Affected organs need to be related to sarcoidosis using an appropriate diagnostic assessment instrument. To declare the recovery of sarcoidosis, all manifestations must have disappeared spontaneously or after 3-5 years post-treatment without relapse.
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17
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Mycobacterium Avium Complex Presenting as Pulmonary Nodules in a Child With Sickle Cell Disease. J Pediatr Hematol Oncol 2019; 41:e409-e412. [PMID: 30933021 DOI: 10.1097/mph.0000000000001458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The case of a 10-year-old child with sickle cell disease with pulmonary nodules and prolonged fevers is reported here. The child was first diagnosed with sarcoidosis based on lung biopsy, but unresponsiveness to therapy led to a second lung biopsy, which revealed the true diagnosis of mycobacterium avium complex disease. Multiple possible explanations for why the patient became infected exist. The patient was baseline immunocompromised due to her sickle cell disease, was exposed to invasive procedures, was taking medications that may predispose to this type of infection, and was found to have a congenital immunodeficiency.
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18
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Heydari-Kamjani M, Vante I, Uppal P, Demory Beckler M, Kesselman MM. Uveitis Sarcoidosis Presumably Initiated After Administration of Shingrix Vaccine. Cureus 2019; 11:e4920. [PMID: 31423396 PMCID: PMC6692093 DOI: 10.7759/cureus.4920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Uveitis is a form of intraocular inflammation that can occur as a result of infection, injury, vaccination, or as a systemic manifestation of autoimmune or inflammatory diseases including sarcoidosis. Sarcoidosis is an inflammatory disease that involves the formation of abnormal granulomas in multiple organ systems. The hallmark of sarcoidosis is a non-caseating granuloma seen on biopsy. Here, we present a case report of a healthy 56-year-old Caucasian female who presented with uveitis sarcoidosis that was presumably initiated after administration of the Shingrix vaccine. Shingrix is a new attenuated subunit vaccine for Varicella Zoster Virus with an AS01B adjuvant that can result in a potent immune response. The Shingrix vaccine is made using Chinese hamster ovary cells which can contaminate the final vaccination product. Together, through the process of molecular mimicry and strong induction of the immune response, administration of Shingrix may have caused or exasperated this patient’s autoimmune etiology.
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Affiliation(s)
- Milad Heydari-Kamjani
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Ivanka Vante
- Family Medicine, Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Paven Uppal
- Miscellaneous, Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Michelle Demory Beckler
- Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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19
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Santosa A, Wong CF, Koh LW. Multisystemic sarcoidosis-important lessons learnt from one of the great imitators. BMJ Case Rep 2019; 12:e227929. [PMID: 30904884 PMCID: PMC6453389 DOI: 10.1136/bcr-2018-227929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 12/29/2022] Open
Abstract
We report a case of a woman who was admitted with a suspicion of metastatic malignancy of unknown primary origin. A few months prior to her admission, she presented to a rheumatologist with acute anterior uveitis, psoriasiform rashes and polyarthritis. A diagnosis of psoriatic arthropathy was made and she was treated accordingly. Soon after she presented with persistent back and right upper quadrant abdominal pain for which she had a CT scan done with evidence of hilar lymphadenopathy, liver hypodensities and lytic-sclerotic bone lesions. She was referred to our hospital for further investigations and management. After re-exploring her clinical presentation and further investigations (including a liver biopsy), a diagnosis of multisystemic sarcoidosis with ocular, reticuloendothelial, hepatic and skeletal involvement was made. The patient was started on systemic glucocorticoids and second line immunosuppressants and demonstrated significant clinical improvement with resolution of her liver granulomata on imaging and improvement in her back pain. The case illustrates the importance of a thorough clinical assessment, review of investigations and an open mind in the evaluation of a patient.
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Affiliation(s)
- Anindita Santosa
- Medicine (Rheumatology), Changi General Hospital, Singapore, Singapore, Singapore
| | | | - Li Wearn Koh
- Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
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20
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Wang SH, Chung CH, Huang TW, Tsai WC, Peng CK, Huang KL, Perng WC, Chian CF, Chien WC, Shen CH. Bidirectional association between tuberculosis and sarcoidosis. Respirology 2019; 24:467-474. [PMID: 30722101 DOI: 10.1111/resp.13482] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/03/2018] [Accepted: 01/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Tuberculosis (TB) and sarcoidosis are both granulomatous diseases with potential interassociations. However, much uncertainty remains; thus, the present study aimed to clarify the association between these diseases. METHODS We established two cohorts in this retrospective longitudinal cohort study using data obtained from the Taiwan National Health Insurance Database from 2000 to 2015. One cohort, which comprised 31 221 patients with TB and 62 442 age-, sex- and index year-matched controls, was used to analyse the risk of sarcoidosis; the other cohort comprised 2442 patients with sarcoidosis and 9688 controls and was used to assess the risk of TB. A Cox proportional hazards model adjusted for potential confounders was used in each cohort. RESULTS Patients with TB showed an 8.09-fold higher risk of developing sarcoidosis than non-TB subjects (95% CI = 3.66-17.90), whereas patients with sarcoidosis showed a 1.85-fold higher risk of developing TB than non-sarcoidosis subjects (95% CI = 1.36-2.50). The TB subtype analysis revealed the highest risk of developing sarcoidosis in patients with extrapulmonary TB, and the highest risk of developing extrapulmonary TB was observed in patients with sarcoidosis compared with non-sarcoidosis subjects. Patients with TB showed a higher risk of developing sarcoidosis throughout the follow-up period, but patients with sarcoidosis only showed a higher risk of developing TB within the first year. CONCLUSION TB is a risk factor for developing sarcoidosis. The results of this bidirectional cohort study also highlight the clinical difficulty of diagnosing sarcoidosis and TB.
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Affiliation(s)
- Sheng-Huei Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Chiuan Tsai
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Lun Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wann-Cherng Perng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Feng Chian
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hao Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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21
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Tchernev G, Lotti T, Wollina U, Cardoso JC, Popova LV, Maximov GK, Lozev I, Terziev I. Sarcoidosis in A. C. Milan (1899)? Open Access Maced J Med Sci 2018; 6:99-102. [PMID: 29483997 PMCID: PMC5816331 DOI: 10.3889/oamjms.2018.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/17/2017] [Accepted: 10/20/2017] [Indexed: 11/06/2022] Open
Abstract
The pathogenesis, diagnosis and therapy of sarcoidosis as an autonomous disease are subjects of spirited discussions, which haven’t found definitive conclusion yet. Distinguishing between sarcoidosis and sarcoid-like reactions (sarcoid - type granulomas) is not currently a medical “gold standard” and is not implemented in clinical practice. This leads to 1) misinterpretation of numerous available data; 2) difficulty in the interpretation of other unverified data, which is often followed by 3) inappropriate or inadequate therapeutic approach. Similarly to many other diseases, in sarcoidosis and sarcoid - types of reactions the concept of personalised approach and therapy should also be introduced. This methodology of clinical guidance is difficult, complex and not always achievable in the current medical status and relations (doctor-patient relationship; financial factor; time factor). It is appropriate to note that in some cases the guidelines or the so-called standards are neglected or not possible to put into practice with the aim of better therapeutic practices and strategies, as well as the achievement of optimal final clinical results (especially in patients with sarcoid granulomas). The sarcoid granuloma, even when it is sterile, should not be considered as the equivalent of sarcoidosis, i.e., sarcoidosis as an autonomous disease. Sure enough, exactly because of this fact, the personalised approach should not be an exception, but it has to gradually become a rule in medical practice. When clinical decisions are conformed to some of the latest modern concepts, officialised in the international databases, often the achieved results can be much better. We present a patient with a tattoo of AC Milan (1899) on his right arm, who subsequently developed localised sterile sarcoid granulomas in the area of the tattoo. Later the process became generalised on his whole body’s skin, lungs and lymph nodes. It is unclear for the moment whether this condition should be interpreted as sarcoidosis as an autonomous disease or, instead, as a sarcoidal type of reaction with subsequent generalisation due to cross-reactivity against antigens present in other tissues with similarities to the exogenous pigments. Following the modern concepts regarding the pathogenesis of these two conditions, we introduced, in this case, an innovative, non-standard approach: 1) systemic and local immunosuppressive therapy, combined with 2) recommеndation for immediate surgical excision of the tattoo to remove the possible trigger of molecular and antigen mimicry.
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Affiliation(s)
- Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.,"Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
| | - Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - José Carlos Cardoso
- Dermatology Department, Coimbra Hospital and University Center, Praceta Mota Pinto, Coimbra, Portugal
| | | | - Georgi Konstantinov Maximov
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - Ilia Lozev
- Medical Institute of Ministry of Interior, Department of General, Vascular and Abdominal Surgery, General Skobelev 79, 1606 Sofia, Bulgaria
| | - Ivan Terziev
- Medical Institute of Ministry of Interior, Department of General, Vascular and Abdominal Surgery, General Skobelev 79, 1606 Sofia, Bulgaria
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22
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Utino FL, Damiani GV, Garcia M, Soares TCB, Stelini RF, Velho PENF, de Souza EM, Cintra ML. Histomorphometric approach to differentiate skin lesions of tuberculoid leprosy from sarcoidosis. J Cutan Pathol 2017; 45:111-117. [DOI: 10.1111/cup.13064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/04/2017] [Accepted: 10/19/2017] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Marina Garcia
- Pathology Department; University of Campinas (UNICAMP); Campinas Brazil
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23
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Ohshimo S, Guzman J, Costabel U, Bonella F. Differential diagnosis of granulomatous lung disease: clues and pitfalls. Eur Respir Rev 2017; 26:26/145/170012. [PMID: 28794143 PMCID: PMC9488688 DOI: 10.1183/16000617.0012-2017] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/25/2017] [Indexed: 01/11/2023] Open
Abstract
Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi) and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis). Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis. A multidisciplinary approach is crucial for the accurate differential diagnosis of granulomatous lung diseaseshttp://ow.ly/FxsP30cebtf
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Larsen BT, Smith ML, Elicker BM, Fernandez JM, de Morvil GAAO, Pereira CAC, Leslie KO. Diagnostic Approach to Advanced Fibrotic Interstitial Lung Disease: Bringing Together Clinical, Radiologic, and Histologic Clues. Arch Pathol Lab Med 2016; 141:901-915. [DOI: 10.5858/arpa.2016-0299-sa] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Idiopathic pulmonary fibrosis (IPF) is a distinctive clinicopathologic entity and the most common form of progressive diffuse lung scarring in older adults. Idiopathic pulmonary fibrosis manifests histopathologically as the usual interstitial pneumonia pattern. The usual interstitial pneumonia pattern is distinguished by geographically and temporally heterogeneous fibrosis that is peripherally accentuated, often with honeycombing and traction bronchiectasis. Idiopathic pulmonary fibrosis is not the only disease that leads to end-stage lung fibrosis, however, and several other entities may also cause advanced fibrosis. Surgical lung biopsies often present a diagnostic dilemma when they show clear evidence of advanced fibrosis, but the clinical, imaging, and/or histopathologic subcharacteristics suggest something other than IPF.
Objective.—
To address this dilemma, we review several other fibrotic lung diseases, including connective tissue disease–associated interstitial lung disease, chronic hypersensitivity pneumonitis, advanced pulmonary Langerhans cell histiocytosis, end-stage pulmonary sarcoidosis, Erdheim-Chester disease, Hermansky-Pudlak syndrome, and others, detailing their clinical, radiologic, and histopathologic attributes and emphasizing similarities to and differences from IPF.
Data Sources.—
Data sources comprised published peer-reviewed literature and personal experience of the authors.
Conclusions.—
Often, clues in the lung biopsy may offer the first suggestion of a fibrotic lung disease other than IPF, and accurate classification is important for prognosis, treatment, and the development of future therapies.
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Affiliation(s)
| | | | | | | | | | | | - Kevin O. Leslie
- From the Department of Laboratory Medicine & Pathology (Drs Larsen, Smith, and Leslie), Mayo Clinic, Scottsdale, Arizona; the Department of Radiology (Dr Elicker), University of California, San Francisco; Juan Max Boettner Hospital (Drs Fernandez and Arbo-Oze de Morvil), Asunción, Paraguay; and the Department of Medicine (Dr Pereira), Federal University of São Paulo, São Paulo, Brazil
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25
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SEVERE PANUVEITIS, RETINAL VASCULITIS, AND OPTIC DISK GRANULOMA SECONDARY TO SARCOIDOSIS. Retin Cases Brief Rep 2015; 10:341-4. [PMID: 26650564 DOI: 10.1097/icb.0000000000000254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of panuveitis, retinal vasculitis, and optic disk granuloma due to sarcoidosis. METHODS Case report and literature review. RESULTS A 26-year-old previously healthy African American male presented with four months of gradual progressive visual decline in the right eye. Clinical examination revealed severe panuveitis, retinal vasculitis, and large optic nerve mass lesion. Diffuse supraclavicular lymphadenopathy was also present. Histopathologic examination of the lymph node biopsy revealed granulomatous inflammation with some areas of caseous necrosis consistent with sarcoidosis. CONCLUSION Sarcoidosis is a common cause of uveitis and retinal vasculitis. In rare cases, an optic disk granuloma may occur and can be treated with immunosuppressive therapy.
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26
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Abstract
Sarcoidosis is a diagnosis of exclusion; there exists neither a pathognomonic clinical feature nor a perfect diagnostic test. Missed diagnosis and overdiagnosis are common. A careful history and physical examination look for "footprints" of sarcoidosis or features suggesting alternative diagnoses. Some presentations are classic and do not require tissue confirmation. A tissue biopsy should be performed if doubt exists. Sampling intrathoracic disease by transbronchial or ultrasound-guided biopsy of mediastinal lymph nodes provide high diagnostic yield with low complication rates. Even with tissue confirmation, diagnosis is never secure and follow-up is required to be fully confident of the diagnosis.
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27
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Chen J, Carter R, Maoz D, Tobar A, Sharon E, Greif F. Breast Cancer and Sarcoidosis: Case Series and Review of the Literature. Breast Care (Basel) 2015. [PMID: 26195943 DOI: 10.1159/000381324] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis is a chronic inflammatory disease of unknown etiology, which can involve different organs and systems. Accordingly, sarcoidosis can mimic breast cancer, making the differential diagnosis very difficult. CASE REPORT 5 patients with a diagnosis of both sarcoidosis and breast cancer followed by the Rabin Medical Center between January 1993 and June 2012 were enrolled in this study. Additionally, a comprehensive literature review which identified 104 patients diagnosed with breast cancer and sarcoidosis was carried out. In both populations reviewed, the average age at diagnosis of sarcoidosis and breast cancer was 57 years. Among the 66 patients with both sarcoidosis and breast cancer, sarcoidosis preceded breast cancer in 31 cases, followed it in 23 cases, and appeared concurrently in 10 cases. CONCLUSION Based on our clinical cases and literature review, a histological study is recommended over imaging if sarcoidosis or breast cancer may be present. Furthermore, breast cancer is rarely associated with sarcoidosis or sarcoidosis-like reaction.
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Affiliation(s)
- Jacob Chen
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; US Army Institute of Surgical Research, Fort Sam, Houston, TX, USA
| | - Robert Carter
- US Army Institute of Surgical Research, Fort Sam, Houston, TX, USA
| | - Daniel Maoz
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Tobar
- US Army Institute of Surgical Research, Fort Sam, Houston, TX, USA
| | - Eran Sharon
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franklin Greif
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Rosen Y. Four decades of necrotizing sarcoid granulomatosis: what do we know now? Arch Pathol Lab Med 2015; 139:252-62. [PMID: 25611109 DOI: 10.5858/arpa.2014-0051-ra] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT In the 4 decades since Dr Averill A. Liebow introduced necrotizing sarcoid granulomatosis, there have been publications of numerous cases, but its nature and possible relationship to classical and nodular sarcoidosis have been and remain controversial. Liebow introduced necrotizing sarcoid granulomatosis as a provisional diagnostic term and stated that "the problem is whether the disease represents necrotizing angiitis with sarcoid reaction, or sarcoidosis with necrosis of the granulomas and of the vessels." There has, as yet, been no definitive answer to the questions that he raised. OBJECTIVE To determine whether there is a relationship between necrotizing sarcoid granulomatosis and nodular sarcoidosis in order to ascertain whether the current prevailing opinion that they are related is correct. DATA SOURCES The world's literature on necrotizing sarcoid granulomatosis from 1973 to 2013 and nodular sarcoidosis from 1952 to 2013 was critically reviewed. One hundred three cases of necrotizing sarcoid granulomatosis and 111 cases of nodular sarcoidosis were found suitable for individual case analysis. CONCLUSIONS The data showed a striking overlap in the clinical, radiologic, and pathologic features of both entities, strongly supporting the conclusion that necrotizing sarcoid granulomatosis is a previously unrecognized manifestation of sarcoidosis and is essentially the same as nodular sarcoidosis. It is proposed that use of necrotizing sarcoid granulomatosis as a diagnostic term be discontinued and replaced by sarcoidosis with necrotizing sarcoid granulomatosis pattern provided that an infectious etiology can be reasonably excluded. Our concept of sarcoidosis should now be expanded to recognize that there is a continuous spectrum of necrosis ranging from minimal to extensive.
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Affiliation(s)
- Yale Rosen
- From the Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York, and the Department of Pathology, Winthrop University Hospital, Mineola, New York
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Solitary sarcoid granuloma of the iris mimicking tuberculosis: a case report. J Ophthalmol 2014; 2014:656042. [PMID: 24734169 PMCID: PMC3964902 DOI: 10.1155/2014/656042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/05/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction. We report a case of a male patient presented with sarcoid lesions of the iris and conjunctiva, mimicking tuberculosis due to epithelioid cell granulomas with small central necrosis in conjunctival biopsy. Patient. A 25-year-old man was referred to our department for further management of an “iris tumor with iridocyclitis” in his right eye. Initial examination showed an isolated vascular tumor of the iris and ciliary body with anterior uveitis and mutton-fat keratic precipitates, suggesting the diagnosis of a granulomatous disease. Conjunctival biopsy revealed granulomatous epithelioid cell inflammation with small central necrosis without acid-fast bacilli. Extensive systemic examination, including bronchoscopy and transbronchial biopsy, provided the diagnosis of sarcoidosis stage 2 with pulmonary involvement, thus ruling out tuberculosis. Systemic and local steroid therapy was initiated, leading to complete recovery of our patient with complete disappearance of the iris lesion and improvement of the pulmonary function. Conclusion. Although noncaseating epithelioid cell granulomas are typical for sarcoidosis, small central necrosis can be found in some granulomas, leading to presumption of tuberculosis. Extensive systemic checkup in cooperation with other specialists is essential to confirm the correct diagnosis and to initiate the appropriate therapy.
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Szepessy Z. Uveitis in sarcoidosis. Orv Hetil 2013; 154:1798-801. [DOI: 10.1556/oh.2013.29724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This case report demonstrates signs of uveitis and difficulties of the differential diagnosis of sarcoidosis as the cause of uveitis. A 57-year-old woman, who had visual loss in her both eyes, developed bilateral panuveitis: bilateral precipitates on the cornea with posterior synechia and infiltrates in the vitreous, and multifocal, peripheral retinochoroiditis. Chest X-ray revealed an infiltrate and numerous smaller granulomas in both lungs. The presumptive diagnosis was tuberculosis, however, biopsy of the pulmonal lesion showed sarcoidosis. Pulmonary and ophthalmologic findings rapidly disappeared with corticosteroid therapy. The author concludes that sarcoidosis may present with different signs of uveitis. Histopathology is of great importance for the differentiation between sarcoidosis and tuberculosis, which is very important for the therapy. Orv. Hetil., 154(45), 1798–1801.
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Affiliation(s)
- Zsuzsanna Szepessy
- Semmelweis Egyetem, Általános Orvostudományi Kar Szemészeti Klinika Budapest Mária u. 39. 1085
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31
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Minami D, Takigawa N, Hayakawa H, Mizuta M, Kudo K, Uchida K, Ichihara E, Sato A, Hotta K, Tabata M, Tanimoto M, Kiura K. Usefulness of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Distinguishing Sarcoidosis from Recurrent Cancer in Patients with Lymphadenopathy after Surgery. Jpn J Clin Oncol 2013; 43:1110-1114. [DOI: 10.1093/jjco/hyt123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Alraies MC, Desai R, Alraiyes AH. Unusual presentation of sarcoidosis--involving testis, spinal cord and the brain. QJM 2013; 106:781-2. [PMID: 22976618 DOI: 10.1093/qjmed/hcs163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M C Alraies
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, 9500 Euclid Avenue, NA21, Cleveland, OH 44195, USA.
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33
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Tuna T, Ozkaya S, Dirican A, Erkan L. An intracerebral mass: tuberculosis or sarcoidosis? BMJ Case Rep 2013; 2013:bcr-2013-009570. [PMID: 23645654 DOI: 10.1136/bcr-2013-009570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is an idiopathic, chronic granulomatous disease and it can affect almost any organ. In autopsy series, it has been reported that the central nervous system involvement has occurred in 5-16% of the patients with sarcoidosis, while the neurological symptoms have occurred only in 3-9% of them. A 40-year-old female patient was admitted to the hospital with complaints of aphasia, balance disorder and drowsiness. An intracerebral mass was detected on cranial CT scans and neurosarcoidosis was diagnosed with clinical, radiological and histopathological findings.
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Affiliation(s)
- Tibel Tuna
- Department of Pulmonary Medicine, Samsun Chest Diseases and Thoracic Surgery Hospital, Samsun, Turkey
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34
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Mroz RM, Korniluk M, Stasiak-Barmuta A, Ossolinska M, Chyczewska E. Increased levels of Treg cells in bronchoalveolar lavage fluid and induced sputum of patients with active pulmonary sarcoidosis. Eur J Med Res 2010; 14 Suppl 4:165-9. [PMID: 20156750 PMCID: PMC3521330 DOI: 10.1186/2047-783x-14-s4-165] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective It has recently been described that circulatory and BAL regulatory T-cells (Tregs), defined as CD4+CD25highCD127low are increased in patients with active sarcoidosis compared with other interstitial lung diseases. Materials and methods We studied prospectively 17 patients (10 women, 7 men) of median age 39 years (range 27-65) with active granulomatous lung diseases (GLD) (10 patients with sarcoidosis (BBS), and 7 with hypersensitivity pneumonitis (HP), and 9 healthy controls. Bronchoalveolar lavage fluid (BAL) and induced sputum Treg counts, CD4+, CD8+, CD25+ cells were quantified by flow cytometry. Disease activity was measured by ACE serum level. Pulmonary function tests were performed using an Elite DL Medgraphics body box. Results We found Treg cells count significantly elevated in induced sputum from active GLD (38.3% vs. 7.1% and 5.3% in BBS, HP, and control, respectively). A significantly higher percentage of Treg cells characterized BAL cells from HP patients (2.27%; 9.5%; 2.1%, in BBS, HP and control, respectively). There was a strong correlation with ACE serum level and Treg cell count in BAL fluid of BBS patients, with no such correlation within HP patient group, nor Treg cell count and pulmonary function tests. Conclusions Our data suggest a potential role of CD4+CD25 high CD127 low induced sputum and BAL lymphocytes from patients with active granulomatous lung diseases and hypersensitivity pneumonitis. An increased number of Treg cells in active GLD may be involved in immune regulation in active granulomatous lung diseases. The results indicate that analysis of these cells could be useful as markers of disease activity in granulomatous lung diseases.
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Affiliation(s)
- R M Mroz
- Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Poland.
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35
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Liu DH, Yao YT, Cui W, Chen K. The association between interleukin-18 and pulmonary sarcoidosis: A meta-analysis. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 70:428-32. [DOI: 10.3109/00365513.2010.506555] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sarcoidosis and its otolaryngological implications. Eur Arch Otorhinolaryngol 2010; 267:1507-14. [PMID: 20617327 DOI: 10.1007/s00405-010-1331-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 06/28/2010] [Indexed: 12/15/2022]
Abstract
Sarcoidosis and its aetiopathogenesis, epidemiology and diagnostic procedures (including the Kveim reaction) are presented in this paper. The clinical manifestations of this disease, especially in otolaryngological organs, including the larynx, salivary glands, nose and paranasal sinuses, are described. Treatment procedures, including surgical interventions and prognosis, are also discussed.
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37
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Rafi H, Latib R, Faik J, Kanouni L, Chami I, Boujida N, Jroundi L. Sarcoïdose mammaire chez une patiente traitée pour cancer du sein. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Nakajima T, Yasufuku K, Kurosu K, Takiguchi Y, Fujiwara T, Chiyo M, Shibuya K, Hiroshima K, Nakatani Y, Yoshino I. The role of EBUS-TBNA for the diagnosis of sarcoidosis – comparisons with other bronchoscopic diagnostic modalities. Respir Med 2009; 103:1796-800. [DOI: 10.1016/j.rmed.2009.07.013] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 06/26/2009] [Accepted: 07/26/2009] [Indexed: 10/20/2022]
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39
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Davis J, Schecter SH, Sowka J. Eales' disease: the great masquerader. OPTOMETRY (ST. LOUIS, MO.) 2009; 80:354-359. [PMID: 19545848 DOI: 10.1016/j.optm.2008.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 07/05/2008] [Accepted: 10/17/2008] [Indexed: 05/28/2023]
Abstract
BACKGROUND Eales' disease, also known as idiopathic retinal periphlebitis, is a diagnosis of exclusion, mainly affecting men in the second through fourth decades of life. Although less common in the United States, Eales' disease is widespread in India and certain areas of the Middle East. CASE REPORT A healthy, 42-year-old Filipino man presented with reduced vision in the right eye of 2 days' duration and had recently had a nonrhegmatogenous retinal detachment diagnosed. Clinical findings included angle neovascularization, posterior vitritis, intraretinal hemorrhages, and retinal vascular sheathing in that eye. Systemic evaluation did not disclose an underlying etiology. Eales' disease was diagnosed. Treatment included topical steroids and cycloplegia, along with intravitreal triamcinolone acetonide injection, which yielded an improvement in the vasculitis and vitritis with subsequent visual improvement and stabilization. CONCLUSION Eales' disease should be considered as a differential diagnosis in patients with vasculitis and vitritis.
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Affiliation(s)
- Jeanmarie Davis
- Nova Southeastern University College of Optometry, Ft. Lauderdale, Florida 33027, USA.
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40
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Stjernberg N, Björnstad-Pettersen H, Truedsson H. Flexible fiberoptic bronchoscopy in sarcoidosis. ACTA MEDICA SCANDINAVICA 2009; 208:397-9. [PMID: 7457207 DOI: 10.1111/j.0954-6820.1980.tb01220.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Twenty-nine patients with clinical signs, chest X-ray and histology consistent with sarcoidosis have been studied with flexible fiberoptic bronchoscopy (FFB) and scalene node biopsy. The diagnostic yield from bronchial mucosal biopsies was 41%, and from transbronchial lung biopsy 43%. 52% of the patients showed epithelioid cell granulomas with FFB (lung and/or mucosal biopsies) compared with 79% with scalene node biopsy. Three patients showed extensive bronchial mucosal changes with stenosing processes due to sarcoidosis. Sarcoidosis of the bronchial mucosa is a frequnt finding, and FFB is the best method for discovering bronchial mucosal sarcoidosis with or without stenosing processes. In our opinion, FFB has a place as a routine method in diagnosing sarcoidosis.
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41
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Munkgaard S, Neukirch F. Comparison of biopsy procedures in intrathoracic sarcoidosis. ACTA MEDICA SCANDINAVICA 2009; 205:179-84. [PMID: 425845 DOI: 10.1111/j.0954-6820.1979.tb06027.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A series of 78 patients, mainly young males, with intrathoracic manifestations of sarcoidosis, found on routine chest X-ray, were examined according to a prescheduled program including different biopsy procedures. In 76% the intrathoracic changes were isolated hilar adenopathy, in 9% isolated pulmonary lesions and in 15% hilar adenopathy plus pulmonary lesions. Lymph nodes containing granulomas were found by mediastinoscopy in 41 of 44 patients and by scalene fat pad biopsy in 20 of 34 patients. In 27 of 76 patients granulomas were found by liver biopsy. Complications to the biopsies were more frequent with mediastinoscopy than with the other two biopsy procedures, but no serious complications occurred. Biopsy through mediastinoscopy is thus preferable in patients of this kind. The necessity of doing biopsies to support the diagnosis of sarcoidosis is discussed on the basis of the literature and our own studies. In younger patients with asymptomatic, bilateral hilar adenopathy without pulmonary lesions it seems justifiable to omit biopsy, whereas biopsy is mandatory in patients with unilateral hilar lymph adenopathy and patients with pulmonary lesions. In all cases the course of the disease should be followed for a rather long period.
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42
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Cros D, Gonzalez RG, Mark EJ. Case records of the Massachusetts General Hospital. Case 6-2009. A 37-year-old woman with vertigo, facial weakness, and a generalized seizure. N Engl J Med 2009; 360:802-9. [PMID: 19228624 DOI: 10.1056/nejmcpc0807823] [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] [Indexed: 11/19/2022]
Affiliation(s)
- Didier Cros
- Department of Neurology, Harvard Medical School, USA
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43
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Shetty AK, Gedalia A. Childhood sarcoidosis: A rare but fascinating disorder. Pediatr Rheumatol Online J 2008; 6:16. [PMID: 18811966 PMCID: PMC2559831 DOI: 10.1186/1546-0096-6-16] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 09/23/2008] [Indexed: 12/22/2022] Open
Abstract
Childhood sarcoidosis is a rare multisystemic granulomatous disorder of unknown etiology. In the pediatric series reported from the southeastern United States, sarcoidosis had a higher incidence among African Americans. Most reported childhood cases have occurred in patients aged 13-15 years. Macrophages bearing an increased expression of major histocompatibility class (MHC) II molecules most likely initiate the inflammatory response of sarcoidosis by presenting an unidentified antigen to CD4+ Th (helper-inducer) lymphocytes. A persistent, poorly degradable antigen driven cell-mediated immune response leads to a cytokine cascade, to granuloma formation, and eventually to fibrosis. Frequently observed immunologic features include depression of cutaneous delayed-type hypersensitivity and a heightened helper T cell type 1 (Th1) immune response at sites of disease. Circulating immune complexes, along with signs of B cell hyperactivity, may also be found. The clinical presentation can vary greatly depending upon the organs involved and age of the patient. Two distinct forms of sarcoidosis exist in children. Older children usually present with a multisystem disease similar to the adult manifestations, with frequent hilar lymphadenopathy and pulmonary infiltrations. Early-onset sarcoidosis is a unique form of the disease characterized by the triad of rash, uveitis, and arthritis in children presenting before four years of age. The diagnosis of sarcoidosis is confirmed by demonstrating a typical noncaseating granuloma on a biopsy specimen. Other granulmatous diseases should be reasonably excluded. The current therapy of choice for sarcoidosis in children with multisystem involvement is oral corticosteroids. Methotrexate given orally in low doses has been effective, safe and steroid sparing in some patients. Alternative immunosuppressive agents, such as azathioprine, cyclophosphamide, chlorambucil, and cyclosporine, have been tried in adult cases of sarcoidosis with questionable efficacy. The high toxicity profile of these agents, including an increased risk of lymphoproliferative disorders and carcinomas, has limited their use to patients with severe disease refractory to other agents. Successful steroid sparing treatment with mycophenolate mofetil was described in an adolescent with renal-limited sarcoidosis complicated by renal failure. Novel treatment strategies for sarcoidosis have been developed including the use of TNF-alpha inhibitors, such as infliximab. The long-term course and prognosis is not well established in childhood sarcoidosis, but it appears to be poorer in early-onset disease.
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Affiliation(s)
- Avinash K Shetty
- Division of Pediatric Rheumatology, Louisiana State University Medical Center and Children's Hospital of New Orleans, LA, USA.
| | - Abraham Gedalia
- Division of Pediatric Rheumatology, Louisiana State University Medical Center and Children's Hospital of New Orleans, LA, USA
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Borchert B, Lawrenz T, Bartelsmeier M, Röthemeyer S, Kuhn H, Stellbrink C. Utility of endomyocardial biopsy guided by delayed enhancement areas on magnetic resonance imaging in the diagnosis of cardiac sarcoidosis. Clin Res Cardiol 2007; 96:759-62. [PMID: 17694383 DOI: 10.1007/s00392-007-0557-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 05/28/2007] [Indexed: 10/23/2022]
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45
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Yanagishita T, Watanabe D, Akita Y, Nakano A, Ohshima Y, Tamada Y, Matsumoto Y. Construction of novel in vitro epithelioid cell granuloma model from mouse macrophage cell line. Arch Dermatol Res 2007; 299:399-403. [PMID: 17704931 DOI: 10.1007/s00403-007-0778-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 07/21/2007] [Accepted: 08/01/2007] [Indexed: 10/22/2022]
Abstract
There have been several attempts to make granuloma model to clarify the mechanism of granulomatous diseases like sarcoidosis. However, a unique in vitro model that generates multinucleated giant cell (MGC) through epithelioid cells resembled to human granuloma, has not yet been clearly established. In this study, the generation of granuloma model that forms MGC via epithelioid cells from the mouse macrophage cell line was investigated. A RAW 246.7 mouse macrophage cell line was cultured with lipopolysaccharide (LPS) and concanavalin A (Con A) in various concentrations either alone or both. We found that separate treatment of LPS and Con A induced around 35 and 20% MGC respectively whereas cotreatment of these chemicals drastically accelerated granuloma formation rate and it was around 80%. The highest fusion index (MGC formation rate) was observed at days 7. A gradual increase of tumor necrosis factor alpha (TNF-alpha) production in the culture supernatant was analyzed by enzyme-linked immunosorbent assay (ELISA). And the neutralization of the elevated level of TNF-alpha production by its monoclonal antibody leads to significant decrease of MGC formation. Interestingly, we found that the RAW cells were changed into spindle cells, which morphologically resembled to epithelioid cells and eventually MGC was formed from these spindle cells. Our in vitro granuloma model appeared to be similar with in vivo epithelioid cell granulomas like sarcoidosis. Thus, our model would be useful as in vitro epithelioid granuloma model for analyzing the mechanisms and screening the effective drugs of granulomatous diseases in future.
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Affiliation(s)
- Takeshi Yanagishita
- Department of Dermatology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan.
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Yanardag H, Caner M, Papila I, Uygun S, Demirci S, Karayel T. Diagnostic value of peripheral lymph node biopsy in sarcoidosis: a report of 67 cases. Can Respir J 2007; 14:209-11. [PMID: 17551595 PMCID: PMC2676364 DOI: 10.1155/2007/218947] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A peripheral lymph node (PLN) 1 cm or greater was found in 79 of 546 sarcoidosis patients (14.5%) between 1972 and 2005. Seventy-two of the 79 sarcoidosis patients had a lymph node biopsy performed. Sixty-seven of these biopsy specimens were histologically diagnosed as sarcoidosis, whereas five patients had a reactive adenopathy. For patients with histological diagnosis of sarcoidosis, localizations of the biopsies were as follows: cervical (n=21), supraclavicular (n=20), inguinal (n=11), axillary (n=8), epitrochlear (n=5) and submandibular (n=2). At the time of biopsy, 12 patients had stage 0 disease, 37 patients had stage I disease, 14 patients had stage II disease and four patients had stage III disease. Skin involvement (16.4%) was the most frequently observed type of organ involvement in patients who had enlarged PLNs due to sarcoidosis. In the presence of an enlarged PLN in sarcoidosis, biopsy had a greater diagnostic value compared with other methods, as well as having a relatively low cost (approximately US$120) in Turkey. No procedure-related complications were observed. In conclusion, it is recommended that PLNs be thoroughly examined when sarcoidosis is suspected. If an enlarged PLN is found, biopsy should be routinely performed because it is an easy, convenient and practical method, with a low complication risk and a high sensitivity.
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Affiliation(s)
- Halil Yanardag
- Department of Lung Diseases, Cerrahpaşa Medical Faculty, University of Istanbul, Aksaray, Turkey.
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47
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Datta SN, Freeman A, Amerasinghe CN, Rosenbaum TP. A case of scrotal sarcoidosis that mimicked tuberculosis. ACTA ACUST UNITED AC 2007; 4:227-30. [PMID: 17415355 DOI: 10.1038/ncpuro0777] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 01/24/2007] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 38-year-old man presented with bilateral testicular swelling, night sweats and weight loss with little response to antibiotics. Examination revealed systemic lymphadenopathy and multiple small masses arising from both testes. INVESTIGATIONS Scrotal ultrasound revealed multiple intratesticular, hypoechoic lesions; chest radiograph and abdominal ultrasound were normal. A CT scan revealed multilevel lymphadenopathies. A Heaf (tuberculin) skin test was negative. Testicular biopsy revealed multiple granulomata, some of which showed patchy central necrosis. DIAGNOSIS A diagnosis of tuberculosis was initially made. After 3 months of clinical deterioration despite antitubercular drug therapy, however, the diagnosis was changed to sarcoidosis because blood results revealed hypercalcemia, elevated serum angiotensin-converting enzyme, and an elevated erythrocyte sedimentation rate. MANAGEMENT The patient improved dramatically on corticosteroid therapy, with complete regression of all testicular lesions on imaging after 2 months. Steroids were tapered, then discontinued after 6 months. The patient remained in complete remission, but became oligospermic by the 3 year follow-up.
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Abstract
Granulomas in the lung are common diagnostic problems encountered by pathologists. They occur in a wide range of pulmonary conditions, ranging from common entities to uncommon ones and including both infections and non-infectious diseases. This review summarizes the main histological features that help distinguish various granulomatous lung diseases. It concentrates on the most important and common entities that may be encountered and emphasizes helpful features in the differential diagnosis.
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Affiliation(s)
- O A El-Zammar
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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49
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Drake WP, Dhason MS, Nadaf M, Shepherd BE, Vadivelu S, Hajizadeh R, Newman LS, Kalams SA. Cellular recognition of Mycobacterium tuberculosis ESAT-6 and KatG peptides in systemic sarcoidosis. Infect Immun 2006; 75:527-30. [PMID: 17088357 PMCID: PMC1828402 DOI: 10.1128/iai.00732-06] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sarcoidosis is an enigmatic disease with a pathology similar to that of tuberculosis. We detected Th-1 immune responses to Mycobacterium tuberculosis ESAT-6 and KatG peptides from peripheral blood mononuclear cells from 15/26 sarcoidosis, 1/24 purified-protein-derivative-negative (PPD-) (P < 0.0001, Fisher's exact test), and 7/8 PPD-positive (PPD+) subjects (P = 0.21). This finding provides immunologic links between mycobacteria and systemic sarcoidosis.
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Affiliation(s)
- Wonder P Drake
- Division of Infectious Diseases, Department of Medicine,Vanderbilt University School of Medicine, 1161 21st Avenue, AA2200 MCN, Nashville, TN 37232, USA.
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50
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Kelly DM, Greene CM, Meachery G, O'Mahony M, Gallagher PM, Taggart CC, O'Neill SJ, McElvaney NG. Endotoxin Up-regulates Interleukin-18. Am J Respir Crit Care Med 2005; 172:1299-307. [PMID: 16100009 DOI: 10.1164/rccm.200411-1594oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE AND OBJECTIVES Sarcoidosis is a granulomatous disease of unknown etiology characterized by a helper T-cell type 1-mediated process. Previously we demonstrated a role for interleukin-18 in sarcoidosis. Here we examine the regulation of interleukin-18 in this condition. METHODS Cytokine levels in sarcoid epithelial lining fluid were measured by ELISA. We examined interleukin-18 promoter activity and mRNA and protein levels in the epithelial lining fluid of individuals with active sarcoidosis, and of individuals recovered from sarcoidosis, in response to purified protein derivative of Mycobacterium tuberculosis, beryllium sulfate, zirconium sulfate, aluminum sulfate, and lipopolysaccharide. Endotoxin levels in the epithelial lining fluid of individuals with sarcoidosis, individuals recovered from sarcoidosis, and control subjects were assessed by Limulus amebocyte lysate analysis. Allele-specific polymerase chain reaction was used to genotype 94 patients with sarcoidosis and 97 control subjects for the interleukin-18 -607(A/C) polymorphism. Species-specific polymerase chain reaction identified bacterial DNA in fluid samples. RESULTS Epithelial lining fluid from active sarcoids contained elevated levels of interleukin-18, interferon-gamma, and interleukin-12 compared with recovered patients and also contained significantly higher levels of endotoxin. Depletion of endotoxin from this epithelial lining fluid reduced its effect on the human interleukin-18 promoter in vitro. There was a higher frequency of the -607C allele and -607(C/C) genotype in the sarcoidosis population compared with control subjects; however, this was not associated with a functional response to endotoxin treatment. Finally, bacterial 16S rRNA from Haemophilus influenzae and Moraxella catarrhalis was detected in sarcoid fluid samples. CONCLUSIONS The pathogenesis of sarcoidosis is propagated through the actions of a helper T-cell type 1-driven response. This study shows that gram-negative bacteria may contribute to this effect by upregulating interleukin-18 expression.
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Affiliation(s)
- Deirdre M Kelly
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
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