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Cho RJ, Pandey V, Wong J, Keenan J, Dincer E, Racila E, Allen T, Perlman D, Bhargava M. The role for endobronchial biopsy in the era of endobronchial ultrasound guided transbronchial needle aspiration for the diagnosis of sarcoidosis: a single center experience. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2024; 41:e2024029. [PMID: 38940717 PMCID: PMC11275549 DOI: 10.36141/svdld.v41i2.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/27/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND AND AIM Endobronchial biopsy (EBBX) has been reported to increase diagnostic yield for pulmonary sarcoidosis. The purpose of this study is to investigate the diagnostic yield for EBBX following endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). METHODS We identified a cohort of patients in the University of Minnesota Sarcoidosis Registry who had EBBx and EBUS-TBNA as part of workup for abnormal chest imaging. Data regarding demographics, biopsy approach and technique were recorded. RESULTS Our cohort included 37 patients (53.24±9.5, Male, 22±0.57; 3.8% were African American). In these patients who had EBBX, EBUS-TBNA was performed in 100% of patients and TBBX was performed in 2 patients (5%). EBBX was positive in 9 patients (24%) and EBUS-TBNA was positive in 34 patients (92%). TBBX was diagnostic in one of two patients. EBBX was the only diagnostic tissue in 3 of the 37 patients (8%). Conclusion: The diagnostic yield of EBBX is lower than previously reported, with only 8% of EBBXs demonstrating granulomatous inflammation. However, instrumentation used for obtaining EBBX as well as the presence of visible lesions does influence the diagnostic yield. Studies with adequate power are needed before implementing changes in clinical practice. When performed alongside EBUS-TBNA, EBBX did not significantly add to the diagnostic yield in sarcoidosis unless visible lesions were observed.
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Affiliation(s)
- Roy J. Cho
- Section of Interventional Pulmonary, Department of pulmonary, allergy, critical care and sleep medicine, University of Minnesota, Minneapolis
| | - Vidhay Pandey
- Department of Medicine, University of Minnesota, Minneapolis
| | - Jennifer Wong
- Section of Interventional Pulmonary, Department of pulmonary, allergy, critical care and sleep medicine, University of Minnesota, Minneapolis
| | - Joseph Keenan
- Section of Interventional Pulmonary, Department of pulmonary, allergy, critical care and sleep medicine, University of Minnesota, Minneapolis
| | - Erhan Dincer
- Section of Interventional Pulmonary, Department of pulmonary, allergy, critical care and sleep medicine, University of Minnesota, Minneapolis
| | | | - Tadashi Allen
- Thoracic Imaging, Department of Radiology, University of Minnesota, Minneapolis
| | - David Perlman
- Section of Interventional Pulmonary, Department of pulmonary, allergy, critical care and sleep medicine, University of Minnesota, Minneapolis
| | - Maneesh Bhargava
- Section of Interventional Pulmonary, Department of pulmonary, allergy, critical care and sleep medicine, University of Minnesota, Minneapolis
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Sharp M, Psoter KJ, Mustafa AM, Chen ES, Lin NW, Mathai SC, Gilotra NA, Eakin MN, Wise RA, Moller DR, McCormack MC. Pulmonary sarcoidosis: differences in lung function change over time. Thorax 2024:thorax-2023-221309. [PMID: 38906696 DOI: 10.1136/thorax-2023-221309] [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: 12/14/2023] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Given the heterogeneity of sarcoidosis, predicting disease course of patients remains a challenge. Our aim was to determine whether the 3-year change in pulmonary function differed between pulmonary function phenotypes and whether there were differential longitudinal changes by race and sex. METHODS We identified individuals seen between 2005 and 2015 with a confirmed diagnosis of sarcoidosis who had at least two pulmonary function test measurements within 3 years of entry into the cohort. For each individual, spirometry, diffusion capacity, Charlson Comorbidity Index, sarcoidosis organ involvement, diagnosis duration, tobacco use, race, sex, age and medications were recorded. We compared changes in pulmonary function by type of pulmonary function phenotype and for demographic groups. RESULTS Of 291 individuals, 59% (173) were female and 54% (156) were black. Individuals with restrictive pulmonary function phenotype had significantly greater 3-year rate of decline of FVC% (forced vital capacity) predicted and FEV1% (forced expiratory volume in 1 s) predicted course when compared with normal phenotype. We identified a subset of individuals in the cohort, highest decliners, who had a median 3-year FVC decline of 156 mL. Black individuals had worse pulmonary function at entry into the cohort measured by FVC% predicted, FEV1% predicted and diffusing capacity for carbon monoxide % predicted compared with white individuals. Black individuals' pulmonary function remained stable or declined over time, whereas white individuals' pulmonary function improved over time. There were no sex differences in rate of change in any pulmonary function parameters. SUMMARY We found significant differences in 3-year change in pulmonary function among pulmonary function phenotypes and races, but no difference between sexes.
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Affiliation(s)
- Michelle Sharp
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kevin J Psoter
- Pediatrics, Division of General Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ali M Mustafa
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Edward S Chen
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nancy W Lin
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stephen C Mathai
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nisha A Gilotra
- Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Eakin
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Robert A Wise
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - David R Moller
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Meredith C McCormack
- Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Harper LJ, Tauquir A, Huang S, Wang X, Schupp JC, Baughman R, Culver DA. Comparison of organ involvement clusters in Black and White American sarcoidosis patients from a prospectively collected patient registry. Respir Med 2024; 226:107605. [PMID: 38537782 DOI: 10.1016/j.rmed.2024.107605] [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: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Due to the heterogeneity of sarcoidosis, there is a need to define clinical phenotypes to allow for tailoring of clinical care and identification of more homogenous populations to facilitate research. METHODS We utilized data from a prospectively collected registry of sarcoidosis patients seen at a single quaternary referral center between January 2019 and February 2021. We used multiple correspondence analysis (MCA) and k-means clustering to investigate if the clusters previously identified in the GenPhenReSa study were reproducible in a US population. We also investigated if these clusters were stable when the population was stratified by race. RESULTS We replicated 3 of the 5 clusters seen in the GenPhenReSa study in our cohort. We likewise identified similar clusters between White and Black patients with sarcoidosis. Differences in organ manifestations associations between White and Black patients were seen primarily in relation to cardiac, neurologic, and ocular involvement. CONCLUSIONS The organ clusters of liver-spleen, isolated pulmonary, and musculoskeletal-skin were reproducible in a US cohort, and in both Black and White patients.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Anoosha Tauquir
- Department of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shuaiqi Huang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Daniel A Culver
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA
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Van Woensel J, Koopman B, Schiefer M, van Kan C, Janssen MTFH, Ramiro S, Magro-Checa C, Landewé RB, de Kruif MD, Bresser P, Mostard RLM. Organ involvement in newly diagnosed sarcoidosis patients in the Netherlands: The first large European multicentre prospective study. Respir Med 2024; 226:107608. [PMID: 38582302 DOI: 10.1016/j.rmed.2024.107608] [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: 07/07/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Clinical presentation and prevalence of organ involvement is highly variable in sarcoidosis and depends on ethnic, genetic and geographical factors. These data are not extensively studied in a Dutch population. AIM To determine the prevalence of organ involvement and the indication for systemic immunosuppressive therapy in newly diagnosed sarcoidosis patients in the Netherlands. METHODS Two large Dutch teaching hospitals participated in this prospective cohort study. All adult patients with newly diagnosed sarcoidosis were prospectively included and a standardized work-up was performed. Organ involvement was defined using the WASOG instrument. RESULTS Between 2015 and 2020, a total of 330 patients were included, 55% were male, mean age was 46 (SD 14) years. Most of them were white (76%). Pulmonary involvement including thoracic lymph node enlargement was present in 316 patients (96%). Pulmonary parenchymal disease was present in 156 patients (47%). Ten patients (3%) had radiological signs of pulmonary fibrosis. Cutaneous sarcoidosis was present in 74 patients (23%). Routine ophthalmological screening revealed uveitis in 29 patients (12%, n = 256)). Cardiac and neurosarcoidosis were diagnosed in respectively five (2%) and six patients (2%). Renal involvement was observed in 11 (3%) patients. Hypercalcaemia and hypercalciuria were observed in 29 (10%) and 48 (26%, n = 182) patients, respectively. Hepatic involvement was found in 6 patients (2%). In 30% of the patients, systemic immunosuppressive treatment was started at diagnosis. CONCLUSIONS High-risk organ involvement in sarcoidosis is uncommon at diagnosis. Indication for systemic immunosuppressive therapy was present in a minority of patients.
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Affiliation(s)
- Julie Van Woensel
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands
| | - Bart Koopman
- Department of Respiratory Medicine, OLVG, Amsterdam, the Netherlands
| | - Mart Schiefer
- Department of Respiratory Medicine, ETZ, Tilburg, the Netherlands
| | - Coen van Kan
- Department of Respiratory Medicine, OLVG, Amsterdam, the Netherlands
| | - Marlou T F H Janssen
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg, the Netherlands; Department of Rheumatology, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - César Magro-Checa
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg, the Netherlands
| | - Robert Bm Landewé
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg, the Netherlands; Amsterdam Rheumatology Centre, AMC, Amsterdam, the Netherlands
| | - Martijn D de Kruif
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands
| | - Paul Bresser
- Department of Respiratory Medicine, OLVG, Amsterdam, the Netherlands
| | - Rémy L M Mostard
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
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Tan MC, Yeo YH, Mirza N, San BJ, Tan JL, Lee JZ, Mazzarelli JK, Russo AM. Trends and Disparities in Cardiovascular Death in Sarcoidosis: A Population-Based Retrospective Study in the United States From 1999 to 2020. J Am Heart Assoc 2024; 13:e031484. [PMID: 38533928 PMCID: PMC11179790 DOI: 10.1161/jaha.123.031484] [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: 06/21/2023] [Accepted: 12/06/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Despite significant cardiac involvement in sarcoidosis, real-world data on death due to cardiovascular disease among patients with sarcoidosis is not well established. METHODS AND RESULTS We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for data on patients with sarcoidosis aged ≥25 years from 1999 to 2020. Diseases of the circulatory system except ischemic heart disease were listed as the underlying cause of death, and sarcoidosis was stated as a contributing cause of death. We calculated age-adjusted mortality rate (AAMR) per 1 million individuals and determined the trends over time by estimating the annual percentage change using the Joinpoint Regression Program. Subgroup analyses were performed on the basis of demographic and geographic factors. In the 22-year study period, 3301 cardiovascular deaths with comorbid sarcoidosis were identified. The AAMR from cardiovascular deaths with comorbid sarcoidosis increased from 0.53 (95% CI, 0.43-0.65) per 1 million individuals in 1999 to 0.87 (95% CI, 0.75-0.98) per 1 million individuals in 2020. Overall, women recorded a higher AAMR compared with men (0.77 [95% CI, 0.74-0.81] versus 0.58 [95% CI, 0.55-0.62]). People with Black ancestry had higher AAMR than people with White ancestry (3.23 [95% CI, 3.07-3.39] versus 0.39 [95% CI, 0.37-0.41]). A higher percentage of death was seen in the age groups of 55 to 64 years in men (23.11%) and women (21.81%), respectively. In terms of US census regions, the South region has the highest AAMR from cardiovascular deaths with comorbid sarcoidosis compared with other regions (0.78 [95% CI, 0.74-0.82]). CONCLUSIONS The increase of AAMR from cardiovascular deaths with comorbid sarcoidosis and higher cardiovascular mortality rates among adults aged 55 to 64 years highlight the importance of early screening for cardiovascular diseases among patients with sarcoidosis.
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Affiliation(s)
- Min Choon Tan
- Department of Internal MedicineNew York Medical College at Saint Michael’s Medical CenterNewarkNJUSA
- Department of Cardiovascular MedicineMayo ClinicPhoenixAZUSA
| | - Yong Hao Yeo
- Department of Internal Medicine/PediatricsBeaumont HealthRoyal OakMIUSA
| | - Noreen Mirza
- Department of Internal MedicineNew York Medical College at Saint Michael’s Medical CenterNewarkNJUSA
| | | | - Jian Liang Tan
- Department of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Justin Z. Lee
- Department of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | - Joanne K. Mazzarelli
- Department of MedicineCooper University Health System/Cooper Medical School of Rowan UniversityCamdenNJUSA
| | - Andrea M. Russo
- Department of MedicineCooper University Health System/Cooper Medical School of Rowan UniversityCamdenNJUSA
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Rosenbaum JT, Pasadhika S. Ocular Sarcoidosis. Clin Chest Med 2024; 45:59-70. [PMID: 38245371 DOI: 10.1016/j.ccm.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis frequently affects the eye and can do so in many different ways. Sarcoidosis causing uveitis can have distinctive features that facilitate identifying sarcoidosis as the cause of the uveitis. Progress is being made in elucidating ocular sarcoidosis, as for example, by transcriptomics, genetics, therapy, and imaging.
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Affiliation(s)
- James T Rosenbaum
- Legacy Devers Eye Institute, 1040 NW 22nd Avenue, Portland, OR 97210, USA; Corvus Pharmaceuticals, 863 Mitten Road Street 102, Burlingame, CA 94010, USA.
| | - Sirichai Pasadhika
- Legacy Devers Eye Institute, 1040 NW 22nd Avenue, Portland, OR 97210, USA
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Vu PQ, Pathak PR, Patel S, Basu AK, Antony MA, Reddy AD, Mathew J. Extra-pulmonary Cutaneous Sarcoidosis Presenting With Granulomatous Cranial Lesions and Cardiac Complications: A Case Report. Cureus 2024; 16:e53290. [PMID: 38435864 PMCID: PMC10905987 DOI: 10.7759/cureus.53290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Sarcoidosis is a non-caseating granulomatous disorder affecting multiple organs. Although the lungs are the most common site of presentation, extra-pulmonary manifestations involving the skin and heart can occur. Sarcoidosis affecting skull bone is uncommon and involvement of skin, heart, and skull bone all together, without pulmonary manifestations, is extremely rare. We report a 63-year-old Caucasian woman with a past history of cutaneous sarcoidosis and granulomatous skull bone lesions who presented with recurrent syncope. An ambulatory cardiac monitor detected intermittent high-grade atrioventricular block and cardiac MRI confirmed the diagnosis of cardiac sarcoidosis. This case represents an extremely unique journey of sarcoidosis and suggests potential consideration for cardiac sarcoidosis screening in patients with a history of extra-cardiac manifestations.
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Affiliation(s)
- Paul Q Vu
- Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Prutha R Pathak
- Internal Medicine, North Alabama Medical Center, Florence, USA
| | | | | | - Mc Anto Antony
- Endocrinology, Diabetes, and Metabolism, Medical University of South Carolina, Anderson, USA
| | - Amogh D Reddy
- Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Jason Mathew
- Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
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Lee JH, Han YE, Yang J, Kim HC, Lee J. Clinical manifestations and associated factors of uveitis in patients with pulmonary sarcoidosis: a case control study. Sci Rep 2023; 13:22380. [PMID: 38104161 PMCID: PMC10725472 DOI: 10.1038/s41598-023-49894-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023] Open
Abstract
Sarcoidosis, an idiopathic and inflammatory disease, affects various organs and can manifest as uveitis. Due to limited evidence, researchers investigated the risk factors associated with uveitis in patients with pulmonary sarcoidosis. A retrospective study was conducted on 71 pulmonary sarcoidosis patients, including 19 with uveitis and 52 without. Data on involved organs, imaging findings, spirometry, and analyses from blood and bronchoalveolar lavage fluid were collected. Logistic regression models were used for multivariate analysis. Among the 71 newly diagnosed pulmonary sarcoidosis patients, uveitis was observed in 19 patients (26.8%). No significant differences were found in clinical characteristics between patients with and without uveitis. Fewer patients with uveitis presented lung parenchymal lesions (P = 0.043). In multivariate analysis, skin lesions (aOR 7.619, 95% CI 1.277-45.472, P = 0.026) and ophthalmic symptoms (aOR 4.065, 95% CI 1.192-13.863, P = 0.025) were associated with uveitis. Absence of uveitis was related to lung parenchymal lesions (aOR 0.233, 95% CI 0.062-0.883, P = 0.032). Approximately one-quarter of patients with an initial diagnosis of pulmonary sarcoidosis were diagnosed with uveitis. Presence of skin lesions, ophthalmic symptoms, and absence of lung parenchymal lesions were related to uveitis. These results need to be clarified by further studies to confirm the clinical role of early ophthalmologic screening for pulmonary sarcoidosis patients with these factors.
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Affiliation(s)
- Jang Ho Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ye Eun Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jiyoul Yang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho Cheol Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Kohli A, Saluja A, Farooqi M, Arora S, Mittal N. Unmasking Sarcoidosis as the Culprit Behind Hypercalcemia-Induced Acute Pancreatitis: A Diagnostic Conundrum. Cureus 2023; 15:e47643. [PMID: 38021853 PMCID: PMC10667954 DOI: 10.7759/cureus.47643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Hypercalcemia-induced pancreatitis is a rare and challenging complication, particularly when secondary to sarcoidosis. This case report discusses the clinical presentation, diagnostic workup, and management of a 61-year-old patient diagnosed with hypercalcemia-induced pancreatitis secondary to sarcoidosis. The abstract highlights the complexities of diagnosing pancreatitis linked to elevated calcium levels and underscores the importance of recognizing underlying conditions such as sarcoidosis in these cases. Through this case, we aim to enhance awareness among clinicians regarding the association between sarcoidosis, hypercalcemia, and pancreatitis, ultimately contributing to improved diagnostic accuracy and patient care strategies.
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Affiliation(s)
- Aditya Kohli
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Anshdeep Saluja
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Saurabh Arora
- Endocrinology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Naveen Mittal
- Endocrinology and Diabetes, Dayanand Medical College and Hospital, Ludhiana, IND
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Stjepanovic M, Mihailovic-Vucinic V, Gvozdenovic BS, Milin-Lazovic J, Belic S, Djurdjevic N, Maric N, Golubovic A. King's Sarcoidosis Questionnaire (KSQ) - Validation study in Serbian speaking population of sarcoidosis patients. PLoS One 2023; 18:e0273126. [PMID: 37669301 PMCID: PMC10479938 DOI: 10.1371/journal.pone.0273126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/24/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION Sarcoidosis is a multiorgan, multisystem chronic disease of unknown etiology and unpredictable course. Health status is reduced in sarcoidosis and assessing it is a difficult multitask effort due to many faces this disease might have. Recently, a new questionnaire for assessing health status in sarcoidosis was developed by a group of authors from England-King's Sarcoidosis Questionnaire (KSQ). The benefit of KSQ is the ability to develop the best care plan for the patient, as well as to differentiate the efficacy of the administered treatment. OBJECTIVE The aim of this study was to validate the KSQ in Serbian speaking population of sarcoidosis patients. The test itself is a modular, multi-organ health status measure for patients with sarcoidosis for use in clinic and the evaluation of therapies. The correlation of KSQ with different clinical course of sarcoidosis (acute vs chronic disease) and with the clinical outcome status (COS) in sarcoidosis was also investigated. METHODS A total of 159 biopsy positive sarcoidosis patients participated in this study. The average age of the participants was 49.67, majority was female (67.3%) and majority had only pulmonary form of sarcoidosis (71.7%). KSQ - new disease-specific health status instrument, was compared with 5 other already existing instruments already used and validated in sarcoidosis (Saint George Respiratory Questionnaire- SGRQ, Daily Activity List -DAL, Fatigue Assessment Scale- FAS, Medical Research Council dyspnea scale-MRC, Borg Dyspnea Scale and 15D as general questionnaire. RESULTS KSQ has significant correlation with other quality of life questionnaires already used in sarcoidosis. Translated version of KSQ shows significant internal reliability, similar to the original KSQ. Serbian version of KSQ has significant correlation with different clinical course of sarcoidosis and with COS as well. The translated version of KSQ is reliable sarcoidosis specific instrument for assessing health status in these patients.
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Affiliation(s)
- Mihailo Stjepanovic
- Clinic of Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Jelena Milin-Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Belic
- Clinic of Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Djurdjevic
- Clinic of Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Maric
- Clinic of Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksa Golubovic
- Clinic of Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
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Khongsit AK, Kumar S, Gupta B, Kumar S. An unusual case of oral sarcoidosis: A diagnostic dilemma. J Oral Maxillofac Pathol 2023; 27:607. [PMID: 38033961 PMCID: PMC10683891 DOI: 10.4103/jomfp.jomfp_552_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/14/2023] [Accepted: 03/06/2023] [Indexed: 12/02/2023] Open
Abstract
Sarcoidosis is a rare type of multi-organ granulomatous disease. It is characterised by non-caseating necrotising granulomatous inflammation. The exact mechanism causing the disease is unknown due to its variation of manifestation in patients. The clinical presentation of this disease is protean, and often, patients remain asymptomatic throughout life. The most commonly affected organ by sarcoidosis is the lung accounting for up to 90% of all cases. Oral manifestation is a relatively rare presentation of sarcoidosis, and there are only a few cases reported till date. In this case report, the authors present a case of oral sarcoidosis of the retromolar trigone region.
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Affiliation(s)
- Anuradha Kar Khongsit
- Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - Shailesh Kumar
- Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - Brijnandan Gupta
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - Subodh Kumar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
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12
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Bergner R. [Sarcoidosis]. Z Rheumatol 2023:10.1007/s00393-023-01338-1. [PMID: 37261551 DOI: 10.1007/s00393-023-01338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 06/02/2023]
Abstract
Sarcoidosis is the most common granulomatous disease in northern Europe. A distinction is made between acute forms of sarcoidosis and chronic sarcoidosis. Chronic sarcoidosis can affect practically all organs but the lungs are affected in 90-95% of patients. The clinical appearance varies between asymptomatic and oligosymptomatic courses, which are diagnosed more by chance, to courses with acute organ failure. An extensive organ work-up is necessary at the time of the initial diagnosis in order to record the extent of organ involvement and to make appropriate treatment decisions. Asymptomatic courses with purely pulmonary sarcoidosis do not require treatment and can be observed over the course of the disease, whereas courses with extensive organ involvement or organ dysfunction require treatment. The treatment consists primarily of the administration of glucocorticoids. If the effect of the glucocorticoids is insufficient or if there are side effects, various immunosuppressive agents, including biologics can be added.
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Affiliation(s)
- Raoul Bergner
- Medizinische Klinik A - Nephrologie, Rheumatologie, Hämato-Onkologie, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
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Ueberham L, Hagendorff A, Klingel K, Paetsch I, Jahnke C, Kluge T, Ebbinghaus H, Hindricks G, Laufs U, Dinov B. Pathophysiological Gaps, Diagnostic Challenges, and Uncertainties in Cardiac Sarcoidosis. J Am Heart Assoc 2023; 12:e027971. [PMID: 36892055 PMCID: PMC10111513 DOI: 10.1161/jaha.122.027971] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cardiac sarcoidosis can mimic any cardiomyopathy in different stages. Noncaseating granulomatous inflammation can be missed, because of the nonhomogeneous distribution in the heart. The current diagnostic criteria show discrepancies and are partly nonspecific and insensitive. Besides the diagnostic pitfalls, there are controversies in the understanding of the causes, genetic and environmental background, and the natural evolution of the disease. Here, we review the current pathophysiological aspects and gaps that are relevant for future cardiac sarcoidosis diagnostics and research.
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Affiliation(s)
- Laura Ueberham
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Karin Klingel
- Cardiopathology Institute for Pathology, Eberhard Karls Universität Tübingen Tübingen Germany
| | - Ingo Paetsch
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Cosima Jahnke
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Theresa Kluge
- Klinik und Poliklinik für Nuklearmedizin Universitätsklinikum Leipzig Leipzig Germany
| | - Hans Ebbinghaus
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Gerhard Hindricks
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Borislav Dinov
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
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14
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Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease of unknown etiology, primarily affecting the lungs and thoracic lymph nodes. Fatigue is a frequent and disabling symptom in sarcoidosis with a significant impact on quality of life. In Denmark, the incidence of sarcoidosis has increased; however, the extent and risk factors of fatigue have not been investigated and no recent reports of the characteristics of patients with sarcoidosis in Denmark exist. AIM To assess the frequency of fatigue in patients with sarcoidosis in Denmark at diagnosis and to investigate if fatigue correlated with relevant disease parameters. Moreover, to characterize patients with sarcoidosis in Denmark at time of diagnosis. METHODS Data were collected in 150 patients with recently diagnosed sarcoidosis. Fatigue was measured using the Fatigue Assessment Scale (FAS). Patients with fatigue were compared to non-fatigue patients regarding clinical parameters. RESULTS FAS was completed by 145 of 150 patients. Fifty-one percent reported significant fatigue. Mean FAS score was 23.6 and 51% had a FAS score ≥ 22. Fatigue in 89 incident patients did not correlate significantly with demographics, physiological, or clinical parameters. Fifty-nine percent were males. Mean age was 47 years; mean values (% predicted) for pulmonary function tests were normal and 71% at Scadding stage 0-I. CONCLUSION In Denmark, fatigue was frequent in patients with sarcoidosis. The majority of patients had mild disease at diagnosis and were older but lower at Scadding stage at diagnosis compared to previous cohorts.
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15
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Zhao T, Yu X, Wang S, Yang L, Su T. Hypercalciuria may predict better response to immunosuppressive therapy in renal sarcoidosis: a case series. J Nephrol 2023; 36:69-82. [PMID: 35696042 DOI: 10.1007/s40620-022-01360-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal sarcoidosis is a rare cause of tubulointerstitial nephritits (TIN). The clinical and pathological characteristics, as well as outcomes, of renal sarcoidosis remain unclear. METHODS This single-center study retrospectively analyzed 18 patients affected by sarcoidosis with tubulointerstitial nephritis (TIN) and 53 patients with tubulointerstitial nephritis not related to sarcoidosis. Patients were further stratified into the granulomatous (12 sarcoidosis and 6 non-sarcoidosis) and non-granulomatous (6 sarcoidosis and 47 non-sarcoidosis) TIN groups. RESULTS Half of the patients with renal sarcoidosis had signs of acute kidney injury at kidney biopsy, 94% of whom presented with extra-renal involvement. The prevalence of hypercalcemia, hypercalciuria, and elevated serum angiotensin-converting enzyme levels was 27.6%, 33.3%, and 31.3%, respectively. Renal sarcoidosis patients with eGFR < 30 mL/min/1.73 m2 scored higher for total chronic tubulointerstitial injury (p = 0.044) and glomerular sclerosis (p = 0.027). Compared to non-sarcoidosis patients, higher urinary calcium levels (for patients with GFR [Formula: see text] 40 mL/min/1.73 m2, p = 0.034), lower scores of acute tubular injury (p = 0.008), and more prominent glomerular sclerosis were observed in renal sarcoidosis. Similar characteristics of chronicity and hypercalciuria were also identified in granulomatous interstitial nephritis; however, interstitial inflammation was obvious (p = 0.001). Patients with renal sarcoidosis were initially treated with corticosteroids. Five patients receiving immunosuppressive agents showed better long-term renal recovery. High 24-h urine calcium (adjusted by weight) was identified as a factor associated with long-term remission. CONCLUSION Renal sarcoidosis is a systemic disease of insidious onset and chronic progression, sharing similar features of chronicity and hypercalciuria with granulomatous interstitial nephritis of other cause. Hypercalciuria may predict a better response to immunosuppressive therapy, presumably indicating active interstitial inflammation; thus, strengthened immunosuppression might be considered.
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Affiliation(s)
- Tao Zhao
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No.8 Xishiku Street, Xicheng District, Beijing, China
| | - Xiaojuan Yu
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No.8 Xishiku Street, Xicheng District, Beijing, China
| | - Suxia Wang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No.8 Xishiku Street, Xicheng District, Beijing, China
| | - Li Yang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No.8 Xishiku Street, Xicheng District, Beijing, China
| | - Tao Su
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No.8 Xishiku Street, Xicheng District, Beijing, China.
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16
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Sharp M, Psoter KJ, Balasubramanian A, Pulapaka AV, Chen ES, Brown SAW, Mathai SC, Gilotra NA, Chrispin J, Bascom R, Bernstein R, Eakin MN, Wise RA, Moller DR, McCormack MC. Heterogeneity of Lung Function Phenotypes in Sarcoidosis: Role of Race and Sex Differences. Ann Am Thorac Soc 2023; 20:30-37. [PMID: 35926103 PMCID: PMC9819274 DOI: 10.1513/annalsats.202204-328oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
Rationale: Historically, sarcoidosis was described as a restrictive lung disease, but several alternative phenotypes of pulmonary function have been observed. Pulmonary function phenotypes in sarcoidosis may represent different clinical and/or molecular phenotypes. Objectives: To characterize the prevalence of different pulmonary function phenotypes in a large and diverse sarcoidosis cohort from a tertiary care referral center. Methods: We identified individuals seen between 2005-2015 with a confirmed diagnosis of sarcoidosis. Data were collected from the first pulmonary function test (PFT) performed at our institution which included spirometry and diffusing capacity of the lung for carbon monoxide (DlCO). Demographics and clinical data were collected. Chi-squared analyses and multiple linear regressions were done to assess statistical differences and associations. Global Lung Function Initiative equations were used to calculate percent predicted measurements for spirometry and DlCO. Results: Of 602 individuals with sarcoidosis, 93% (562) had pulmonary involvement, 64% (385) were female, and 57% (341) were Black. Of those with pulmonary involvement, 56% had abnormal pulmonary function. Lung function impairment phenotypes included: 47% restriction, 22% obstruction, 15% isolated reduction in DlCO, and 16% combined obstructive restrictive phenotype. Restriction was the most common PFT phenotype among Black individuals (41%), while no lung impairment was most common among White individuals (66%) (P < 0.001). Males more frequently had obstruction (19%) compared with females (9%) P = 0.001, and females had more restriction (30%) compared with males (21%) P = 0.031. Conclusions: Among individuals with sarcoidosis and pulmonary function impairment, less than half demonstrated a restrictive phenotype. There were significant differences in pulmonary function phenotypes by race and sex.
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Affiliation(s)
- Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Kevin J. Psoter
- Division of General Pediatrics, Department of Pediatrics, and
| | | | - Anuhya V. Pulapaka
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Edward S. Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, John Hopkins School of Medicine, Baltimore, Maryland; and
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, John Hopkins School of Medicine, Baltimore, Maryland; and
| | - Rebecca Bascom
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard Bernstein
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Robert A. Wise
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - David R. Moller
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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17
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Pulmonary Sarcoidosis: Beyond Restriction and Forced Vital Capacity. Ann Am Thorac Soc 2023; 20:24-26. [PMID: 36584989 PMCID: PMC9819261 DOI: 10.1513/annalsats.202208-731ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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18
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Khalaji A, Rezaei SS, Shajari R, Masoumi M. Sarcoidosis with multiple organ involvement and uncommon symptoms: A case report. Clin Case Rep 2022; 10:e6168. [PMID: 35937005 PMCID: PMC9347326 DOI: 10.1002/ccr3.6168] [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: 04/19/2022] [Revised: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Sarcoidosis is a complicated inflammatory disease characterized by the formation of non-caseating epithelioid granulomas in many organs. Herein, we reported a sarcoidosis case with multiple organ involvements and our diagnostic criteria and treatment plan.
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Affiliation(s)
| | | | - Rasoul Shajari
- Clinical Research and Development CenterShahid Beheshti Hospital, Qom University of Medical Sciences, Shahid Beheshti BoulevardQomIran
| | - Maryam Masoumi
- Clinical Research and Development CenterShahid Beheshti Hospital, Qom University of Medical Sciences, Shahid Beheshti BoulevardQomIran
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19
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Sarcoid Uveitis: An Intriguing Challenger. Medicina (B Aires) 2022; 58:medicina58070898. [PMID: 35888617 PMCID: PMC9316395 DOI: 10.3390/medicina58070898] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of our work is to describe the actual knowledge concerning etiopathogenesis, clinical manifestations, diagnostic procedures, complications and therapy of ocular sarcoidosis (OS). The study is based on a recent literature review and on the experience of our tertiary referral center. Data were retrospectively analyzed from the electronic medical records of 235 patients (461 eyes) suffering from a biopsy-proven ocular sarcoidosis. Middle-aged females presenting bilateral ocular involvement are mainly affected; eye involvement at onset is present in one-third of subjects. Uveitis subtype presentation ranges widely among different studies: panuveitis and multiple chorioretinal granulomas, retinal segmental vasculitis, intermediate uveitis and vitreitis, anterior uveitis with granulomatous mutton-fat keratic precipitates, iris nodules, and synechiae are the main ocular features. The most important complications are cataract, glaucoma, cystoid macular edema (CME), and epiretinal membrane. Therapy is based on the disease localization and the severity of systemic or ocular involvement. Local, intravitreal, or systemic steroids are the mainstay of treatment; refractory or partially responsive disease has to be treated with conventional and biologic immunosuppressants. In conclusion, we summarize the current knowledge and assessment of ophthalmological inflammatory manifestations (mainly uveitis) of OS, which permit an early diagnostic assay and a prompt treatment.
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20
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Kimbrough BA, Warrington KJ, Langenfeld HE, Crowson CS, Carmona EM, Virata AR, Koster MJ. Vasculitis in Patients With Sarcoidosis: A Single-Institution Case Series of 17 Patients. J Clin Rheumatol 2022; 28:217-222. [PMID: 35319536 DOI: 10.1097/rhu.0000000000001839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Vasculitis in patients with sarcoidosis is rare and can affect any sized blood vessel. Limited information describing this association is available. METHODS A single-institution medical records review study was performed reviewing all patients with a diagnosis code for sarcoidosis and vasculitis between January 1, 1998, and December 31, 2019. Data were abstracted regarding diagnosis, treatment, and outcomes from medical records. Patients were diagnosed with vasculitis based on biopsy and/or arterial imaging. Comparison between patients presenting with large and/or medium vessel vasculitis (L/MVV) versus patients with only small vessel vasculitis (SVV) was performed. RESULTS Seventeen patients were identified during the study period. Nine patients (56% female) had L/MVV, and 8 (50% female) had SVV. Sarcoidosis preceded vasculitis in 4 (44%) L/MVV and 3 (38%) SVV. The mean ± SD age at sarcoidosis diagnosis was 53.2 ± 17.8 and 51.9 ± 11.4 years, and the mean ± SD age at vasculitis diagnosis was 57.4 ± 19.6 and 59.0 ± 13.4 years in L/MVV and SVV, respectively. Number of organ systems involved by sarcoidosis was similar (median [interquartile range], 3 [1-4] L/MVV vs 2.5 [1.75-3.25] SVV). The mean length of follow-up was 11.5 ± 12.8 in L/MVV and 13.1 ± 14.3 years in SVV. Complete response to therapy for vasculitis was observed in 8 of 9 with L/MVV and 7 of 8 with SVV. Four patients with SVV were able to stop all immunosuppression as compared with only 1 patient with L/MVV at the last follow-up. CONCLUSIONS This series observed a comparable number of patients with L/MVV and SVV. Although a variety of treatments were used, most patients achieved remission regardless of vessel size affected. Clinicians should be aware of the overlap between sarcoidosis and vasculitis.
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Affiliation(s)
| | | | - Hannah E Langenfeld
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences
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21
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Cardiac sarcoidosis outcome differences: A comparison of patients with de novo cardiac versus known extracardiac sarcoidosis at presentation. Respir Med 2022; 198:106864. [DOI: 10.1016/j.rmed.2022.106864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022]
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22
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Cheng CY, Baritussio A, Giordani AS, Iliceto S, Marcolongo R, Caforio ALP. Myocarditis in systemic immune-mediated diseases: Prevalence, characteristics and prognosis. A systematic review. Autoimmun Rev 2022; 21:103037. [PMID: 34995763 DOI: 10.1016/j.autrev.2022.103037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/02/2022] [Indexed: 12/17/2022]
Abstract
Many systemic immune-mediated diseases (SIDs) may involve the heart and present as myocarditis with different histopathological pictures, i.e. lymphocytic, eosinophilic, granulomatous, and clinical features, ranging from a completely asymptomatic patient to life-threatening cardiogenic shock or arrhythmias. Myocarditis can be part of some SIDs, such as sarcoidosis, systemic lupus erythematosus, systemic sclerosis, antiphospholipid syndrome, dermato-polymyositis, eosinophilic granulomatosis with polyangiitis and other vasculitis syndromes, but also of some organ-based immune-mediated diseases with systemic expression, such as chronic inflammatory bowel diseases. The aim of this review is to describe the prevalence, main clinical characteristics and prognosis of myocarditis associated with SIDs.
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Affiliation(s)
- Chun-Yan Cheng
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Anna Baritussio
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea Silvio Giordani
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Renzo Marcolongo
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alida L P Caforio
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy.
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Blockmans D, Betrains A, Van Laere K. PET Imaging in Rheumatic Diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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24
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Clinical characteristics and outcomes of Korean patients with sarcoidosis. Sci Rep 2021; 11:23700. [PMID: 34880400 PMCID: PMC8654965 DOI: 10.1038/s41598-021-03175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown cause involving multiple organs. Its clinical presentation and prognosis vary among races. We identified the clinical characteristics and outcomes of Korean patients with sarcoidosis. Clinical data of 367 Korean patients with biopsy-proven sarcoidosis diagnosed in 2001–2017 were retrospectively analyzed. Treatment responses included improvement, stability, or progression based on changes in pulmonary sarcoidosis on chest images. The mean age was 47.4 years, and 67.3% of patients were women. The median follow-up period was 80 months. The highest prevalence was observed in individuals aged 50–59 years (30–39 years in men, 50–59 years in women), and the number of diagnoses showed an increasing trend. Lung involvement was the most common (93.5%), followed by the skin, eyes, and extrathoracic lymph nodes. Among patients with lung involvement and a follow-up period of ≥ 3 months, 66.8%, 31.0%, and 2.2% showed improvement, stability, and progression, respectively. Eleven patients (2.9%) died, and the 5-year survival rate was 99%. The number of diagnosed cases showed an increasing trend, and the mean age at diagnosis was increased compared with that in previous reports. Organ involvement was similar to that of Westerners, although the prognosis appeared better.
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25
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Innabi A, Alzghoul BN, Kalra S, Al-Hakim T, Buchanan M, Shivas T, Xue W, Gomez-Manjarres D, Patel DC. Sarcoidosis among US Hispanics in a Nationwide Registry. Respir Med 2021; 190:106682. [PMID: 34788736 DOI: 10.1016/j.rmed.2021.106682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sarcoidosis has been well studied in multiple races and ethnic groups. However, there is a paucity of data that describes sarcoidosis in Hispanics. We aimed to determine the prevalence of Hispanic ethnicity, clinical characteristics and impact of sarcoidosis among Hispanics from a US based national registry. METHODS We conducted a national registry-based study investigating 3835 respondents to the Sarcoidosis Advanced Registry for Cures questionnaire. This registry is a web-based, self-reported questionnaire that provides data related to demographics, diagnostics, organ involvement, treatment modalities, and the physical and psychosocial impact of sarcoidosis. We compared Hispanic patients to non-Hispanics. We performed multivariate logistic regression analysis adjusting for age, gender, education, income and insurance status and looked at the association between Hispanic ethnicity with depression, chronic pain syndrome, chronic fatigue syndrome, impact on family finances, employment-based disability and job termination. RESULTS Nine percent of the patients reported a Hispanic ethnicity and the majority of these patients self-identified as white women. The most common organs involved were the lungs (74.9%), central lymph nodes (53.8%), and peripheral lymph nodes (37.1%). Hispanics reported more peripheral nerves and peripheral lymph nodes involvement than non-Hispanics. Hispanics experienced more depression, sleep apnea, and chronic pain syndrome than non-Hispanics. The use of mobility assistive devices was more common among Hispanics, as well as employment-based disability, and disease-related job termination compared to non-Hispanics. The majority of Hispanics reported significantly more pain that interfered with the enjoyment of life than non-Hispanics. On multivariate logistic regression analysis, Hispanic ethnicity was associated with depression (adjusted odds ratio (aOR) = 1.5; 95% CI: 1.01-2.2), chronic pain syndrome (aOR = 1.7; 1.1-2.6), job termination due to sarcoidosis (aOR = 1.7; 1.1-2.7) and higher impact on family finances (aOR = 1.7; 1.1-2.5). CONCLUSION The clinical presentation of sarcoidosis in Hispanic patients differs from that in non-Hispanic patients living in the United States. These differences should be considered when managing Hispanic patients with sarcoidosis. We encourage more studies that investigate phenotyping among Hispanics with sarcoidosis.
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Affiliation(s)
- Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Saminder Kalra
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | | | - Mindy Buchanan
- Foundation for Sarcoidosis Research; Chicago, Illinois, USA
| | - Tricha Shivas
- Foundation for Sarcoidosis Research; Chicago, Illinois, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine; University of Florida; Gainesville, FL, USA
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Divya C Patel
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA.
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Perlman DM, Sudheendra MT, Racilla E, Allen TL, Joshi A, Bhargava M. Granulomatous-Lymphocytic Interstitial Lung Disease Mimicking Sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021025. [PMID: 34744421 PMCID: PMC8552568 DOI: 10.36141/svdld.v38i3.11114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/12/2021] [Indexed: 11/07/2022]
Abstract
Common variable immunodeficiency (CVID) is one of the most common primary immunodeficiency disorders characterized by hypogammaglobulinemia and inadequate antibody response to immunizations. The impaired antibody response occurs due to the failure of B cells to differentiate into plasma cells resulting in low immunoglobulins levels and increased frequency of infections. Granulomatous and Lymphocytic Interstitial Lung Disease (GLILD) is a non-infectious complication of CVID that is seen in 10-30% of cases. GLILD is a multisystem inflammatory disease involving the lungs, lymph node, liver, spleen and gastrointestinal tract that mimics sarcoidosis. This report describes a series of cases who presented with dyspnea, recurrent respiratory infections or autoimmunity and on further evaluation revealed features suggestive of GLILD. There is very limited understanding of GLILD in terms of clinical presentation, the histo-pathological logical findings, and the diagnostic criteria by itself are limited. A diagnosis of GLILD is established in cases of CVID when there is evidence of lymphoproliferation, cytopenia, autoimmune processes and a lung biopsy demonstrating lymphocytic interstitial pneumonia, follicular bronchiolitis, lymphoid hyperplasia, and/or non-necrotizing granulomas. We review the treatment strategies, including replacement of immunoglobulin and agents targeting B and T lymphocytes. Systematic characterization of GLILD cases and long term follow up studies are sorely needed to understand the natural history of GLILD.
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Affiliation(s)
- David M Perlman
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine University of Minnesota Medical School, Minneapolis, MN, USA
| | - Muthya Tejasvini Sudheendra
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine University of Minnesota Medical School, Minneapolis, MN, USA
| | - Emilian Racilla
- Department of Lab Medicine and Pathology, University of Minnesota Medical School, Minneapolis MN, USA
| | - Tadashi L Allen
- Department of Radiology, University of Minnesota Medical School, Minneapolis MN, USA
| | - Avni Joshi
- Division of Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Maneesh Bhargava
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine University of Minnesota Medical School, Minneapolis, MN, USA
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Abstract
Sarcoidosis is a multisystem disease of unknown cause with heterogenous clinical manifestations and variable course. Spontaneous remissions occur in some patients while others have progressive disease impacting survival, organ function, and quality of life. Four high-risk sarcoidosis phenotypes associated with chronic inflammation have recently been identified as high-priority areas for research. These include treatment-refractory pulmonary disease, cardiac sarcoidosis, neurosarcoidosis and multiorgan sarcoidosis. Significant gaps currently exist in understanding of these high-risk manifestations of sarcoidosis, including their natural history, diagnostic criteria, biomarkers, and the treatment strategy such as the ideal agent, optimal dose and treatment duration. The use of registries with well-phenotyped patients is a critical first step to study high-risk sarcoidosis manifestations systematically. We review the diagnostic and treatment approach to high-risk sarcoidosis manifestations. Appropriately identifying these disease sub-groups will help enroll well-phenotyped patients in sarcoidosis registries and clinical trials, a necessary step to narrow existing gaps in understanding of this enigmatic disease.
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