Coexisting Sickle Cell Anemia and Sarcoidosis: A Management Conundrum!

Hematological involvement in sarcoidosis: from cytopenias to lymphoma

INTRODUCTION

We present an updated overview of the hematological involvementassociated with sarcoidosis, including a management approach forcytopenias and revisiting the association with hematologicalmalignancies.

AREAS COVERED

Theetiology of cytopenias in sarcoidosis can be attributed to two majoretiopathogenic mechanisms: infiltration of hematopoietic organs suchas the spleen and bone marrow, and autoimmune-mediated cytopenias.With respect to the association with hematological malignancies, itrequires careful evaluation of patients from a chronologicalperspective. Patients must be classified into one of three pathogenicscenarios, including preexisting hematological malignancies,synchronous development of malignancy and sarcoidosis due to commonpredisposing factors, or sarcoidosis as a predisposing factor formalignancies.

EXPERT OPINION

The association between sarcoidosis and hematologic involvement isbest understood as a pathogenic continuum, with cytopenias andhematologic neoplasms intertwined due to various etiopathogenicmechanisms. These mechanisms include sarcoid infiltration ofhematopoietic organs, common predisposing immunogenetics for thedevelopment of autoimmune cytopenias and malignancies, and anincreased risk of neoplasm development in patients with autoimmunecytopenias. Collaboration among the main specialties involved in theclinical management of these patients is crucial for an earlymonitoring and management.

Brachial plexitis: an unusual presentation in sickle cell disease

Brachial plexitis is defined as an inflammation of the brachial plexus. There are two entities of the disease: idiopathic, which is generally considered to be immune-mediated, and genetic. The disease manifests as the acute onset shoulder pain, weakness of the involving arm ± sensory loss. Brachial plexitis is also known as Parsonage-Turner syndrome and hereditary neuralgic amyotrophy. Diagnosis is made with the help of history, physical exam, and imaging. Conservative management is the mainstay of treatment. There has not been any proven treatment for the condition though some cases have been treated empirically with steroids. We present a case of 61-year-old woman with sickle cell anemia who presented with right upper extremity weakness and MRI findings of brachial plexitis.