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Sobiecka M, Siemion-Szczesniak I, Burakowska B, Kurzyna M, Dybowska M, Tomkowski W, Szturmowicz M. Sarcoidosis-associated pulmonary hypertension due to pulmonary arteries stenosis - a case report. BMC Pulm Med 2024; 24:346. [PMID: 39014431 PMCID: PMC11251360 DOI: 10.1186/s12890-024-03152-0] [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] [Received: 04/15/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Sarcoidosis-associated pulmonary hypertension (SAPH) is listed in Group 5 of the clinical classification of pulmonary hypertension, due to its complex and multifactorial pathophysiology. The most common cause of SAPH development is advanced lung fibrosis with the associated destruction of the vascular bed, and/or alveolar hypoxia. However, a substantial proportion of SAPH patients (up to 30%) do not have significant fibrosis on chest imaging. In such cases, the development of pulmonary hypertension may be due to the lesions directly affecting the pulmonary vasculature, such as granulomatous angiitis, pulmonary veno-occlusive disease, chronic thromboembolism or external compression of vessels by enlarged lymph nodes. Based on the case of a 69-year-old female who developed SAPH due to pulmonary arteries stenosis, diagnostic difficulties and therapeutic management are discussed. CASE PRESENTATION The patient, non-smoking female, diagnosed with stage II sarcoidosis twelve years earlier, presented with progressive dyspnoea on exertion, dry cough, minor haemoptysis and increasing oedema of the lower limbs. Computed tomography pulmonary angiography (CTPA) showed complete occlusion of the right upper lobe artery and narrowing of the left lower lobe artery, with post-stenotic dilatation of the arteries of the basal segments. The vascular pathology was caused by adjacent, enlarged lymph nodes with calcifications and fibrotic tissue surrounding the vessels. Pulmonary artery thrombi were not found. The patient was treated with systemic corticosteroid therapy and subsequently with balloon pulmonary angioplasty. Partial improvement in clinical status and hemodynamic parameters has been achieved. CONCLUSIONS An appropriate screening strategy is required for early detection of pulmonary hypertension in sarcoidosis patients. Once SAPH diagnosis is confirmed, it is crucial to determine the appropriate phenotype of pulmonary hypertension and provide the most effective treatment plan. Although determining SAPH phenotype is challenging, one should remember about the possibility of pulmonary arteries occlusion.
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Affiliation(s)
- Malgorzata Sobiecka
- 1 st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, Warsaw, 01-138, Poland.
| | - Izabela Siemion-Szczesniak
- 1 st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, Warsaw, 01-138, Poland
| | - Barbara Burakowska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, Warsaw, 01-138, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Center Otwock, Medical Centre for Postgraduate Education, Otwock, Poland
| | - Malgorzata Dybowska
- 1 st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, Warsaw, 01-138, Poland
| | - Witold Tomkowski
- 1 st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, Warsaw, 01-138, Poland
| | - Monika Szturmowicz
- 1 st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, Warsaw, 01-138, Poland
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Yafasova A, Fosbøl EL, Gustafsson F, Krintel SB, Kristensen SL, Schou M, Petersen JK, Sun G, Rossing K, Doi SN, Køber L, Butt JH. Long-Term Risk of VTE in Sarcoidosis: A Nationwide Cohort Study. Chest 2024; 166:136-145. [PMID: 38295951 DOI: 10.1016/j.chest.2024.01.042] [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] [Received: 09/24/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Chronic inflammation is increasingly recognized as a risk factor for VTE, but unlike other inflammatory diseases including systemic lupus erythematosus and rheumatoid arthritis, data on the risk of VTE in patients with sarcoidosis are sparse. RESEARCH QUESTION Do patients with sarcoidosis have a higher long-term risk of VTE (pulmonary embolism or DVT, and each of these individually) compared with the background population? STUDY DESIGN AND METHODS Using Danish nationwide registries, patients aged ≥ 18 years with newly diagnosed sarcoidosis (two or more inpatient/outpatient visits, 1996-2020) without prior VTE were matched 1:4 by age, sex, and comorbidities with individuals from the background population. The primary outcome was VTE. RESULTS We included 14,742 patients with sarcoidosis and 58,968 matched individuals (median age, 44.7 years; 57.2% male). The median follow-up was 8.8 years. Absolute 10-year risks of outcomes for patients with sarcoidosis vs the background population were the following: VTE, 2.9% vs 1.6% (P < .0001), pulmonary embolism, 1.5% vs 0.7% (P < .0001), and DVT, 1.6% vs 1.0% (P < .0001), respectively. In multivariable Cox regression, sarcoidosis was associated with an increased rate of all outcomes in the first year after diagnosis (VTE: hazard ratio [HR], 4.94; 95% CI, 3.61-6.75) and after the first year (VTE: HR, 1.65; 95% CI, 1.45-1.87) compared with the background population. These associations persisted when excluding patients with a history of cancer and censoring patients with incident cancer during follow-up. Three-month mortality was not significantly different between patients with VTE with and without sarcoidosis (adjusted HR, 0.84; 95% CI, 0.61-1.15). INTERPRETATION In this nationwide cohort study, sarcoidosis was associated with a higher long-term risk of VTE compared with a matched background population.
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Affiliation(s)
- Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sophine B Krintel
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Jeppe K Petersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Guoli Sun
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Seiko N Doi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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Taieb D, Pastré J, Juvin K, Bouvry D, Jeny F, Sanchez O, Uzunhan Y, Valeyre D, Nunes H, Israël-Biet D. Prognostic impact of venous thromboembolism on the course of sarcoidosis: A multicenter retrospective case-control study. Respir Med Res 2023; 84:101050. [PMID: 37897877 DOI: 10.1016/j.resmer.2023.101050] [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] [Received: 05/16/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 10/30/2023]
Abstract
Sarcoidosis is an independent risk factor for venous thromboembolism (VTE). However, the characteristics and clinical evolution of sarcoidosis patients presenting a VTE (sarcoidosis/VTE group) in the course of their disease are not known. Consequently, if VTE occurrence is associated with a more severe disease is still pending. We conducted a retrospective case-control study of sarcoidosis/VTE patients compared to matched sarcoidosis controls without VTE in two French tertiary centers, analysed and compared the clinical, biological, functional, imaging and evolutive profiles of the two groups. Sixty-one patients were included with at least one episode of VTE during course of sarcoidosis. At sarcoidosis onset (before/at the time of VTE occurrence) the number of affected organs, radiological stages and pulmonary functional tests were not significantly different between the two groups. In contrast, we found that sarcoidosis/VTE patients required more frequently a systemic immunosuppressive therapy (corticosteroids and/or immunosuppressors, 79% versus 58%; p = 0.008). The functional course was also poorer in sarcoidosis/VTE patients with a more frequent decrease in functional vital capacity (33% versus 18% in sarcoidosis/VTE patients and controls, respectively, p = 0.008). Finally, sarcoidosis/VTE patients presented more frequently with pulmonary hypertension (10% versus 1% in patients and controls, respectively, p = 0.006), and their survival was significantly worse (log-rank p <0.001). The occurrence of VTE during sarcoidosis is associated with a more severe disease and a poorer prognosis. The occurrence of VTE during sarcoidosis might signal a more inflammatory and/or evolutive disease in sarcoidosis/VTE patients and should be taken in consideration when designing therapeutic strategies for them.
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Affiliation(s)
- Dov Taieb
- Service de Pneumologie et Soins Intensifs, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Européen Georges Pompidou, 75015 Paris, France; UFR de Médecine, Université Paris Cité, Paris, France.
| | - Jean Pastré
- Service de Pneumologie et Soins Intensifs, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Karine Juvin
- Service de Pneumologie et Soins Intensifs, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Diane Bouvry
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, 93009 Bobigny, France
| | - Florence Jeny
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, 93009 Bobigny, France; INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Européen Georges Pompidou, 75015 Paris, France; UFR de Médecine, Université Paris Cité, Paris, France
| | - Yurdagül Uzunhan
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, 93009 Bobigny, France; INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Hilario Nunes
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, 93009 Bobigny, France; INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France
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Hussain B, Markson F, Mamas MA, Alraies C, Aggarwal V, Kumar G, Desai R, Paul TK. Effects of Valvular Heart Disease on Clinical Outcomes in Sarcoidosis. Curr Probl Cardiol 2023; 48:101866. [PMID: 37301487 DOI: 10.1016/j.cpcardiol.2023.101866] [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: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Systemic sarcoidosis can lead to heart failure, conduction abnormalities and ventricular arrhythmias although data on concomitant valvular heart disease (VHD) is limited. We reported the prevalence and outcomes of VHD in systemic sarcoidosis. A retrospective cohort study was conducted using National Inpatient Sample between 2016 and 2020 with respective ICD-10-CM codes. 406,315 patients were hospitalized with sarcoidosis, out of which 20,570 had comorbid VHD (5.1%). Mitral disease was most common (2.5%), followed by aortic, and tricuspid disease. Tricuspid disease was associated with increased mortality in sarcoidosis (OR 1.6, 95% CI, 1.1-2.6, P = 0.04), while aortic disease was associated with higher mortality in only 31-50 years age cohort. Patients with sarcoidosis and VHD have higher hospitalization charges and lower or similar valvular intervention rates than those without sarcoidosis. VHD has a prevalence of 5% in sarcoidosis, predominantly affecting mitral and aortic valves. Underlying VHD is associated with worse outcomes in sarcoidosis.
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Affiliation(s)
- Bilal Hussain
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY
| | | | - Mamas A Mamas
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Chadi Alraies
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
| | - Vikas Aggarwal
- Division of Cardiology, University of Michigan, Ann Arbor, MI
| | - Gautam Kumar
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA
| | - Timir K Paul
- University of Tennessee Health Sciences Center at Nashville, Ascension St. Thomas Hospital, Nashville, TN.
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5
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Kawabata H, Satoh M, Hasegawa T, Tanaka S, Hara K, Yatera K. Clinical significance of serum autoantibodies in patients with sarcoidosis. Immunopharmacol Immunotoxicol 2023:1-6. [PMID: 36729062 DOI: 10.1080/08923973.2023.2170242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The association between sarcoidosis and autoimmunity has been reported for years. However, the significance of autoantibodies in the pathophysiology and clinical management of sarcoidosis is not well understood. No autoantibodies that can be used as serologic biomarkers to diagnose the disease, monitor the state of the disease, and predict the prognosis of patients are established. METHODS We performed a comprehensive analysis of serum autoantibodies and analyzed their associations with clinical features of sarcoidosis. RESULTS Patients with systemic autoimmune rheumatic diseases-associated autoantibodies had a higher prevalence of advanced radiographic stage and consolidations in high-resolution computed tomography than patients without autoantibodies (p < .05). Age, sex, clinical history, pulmonary function tests, serum angiotensin-converting enzyme levels, rheumatoid factor, and the number of involved organs were not significantly different between the two groups. CONCLUSIONS There may be an association between autoantibodies and more advanced pulmonary lesions in patients with sarcoidosis. Further investigations are needed to establish the significance of autoantibodies.
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Affiliation(s)
- Hiroki Kawabata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.,Department of Medicine, Kitakyushu Yahata-Higashi Hospital, Kitakyushu, Fukuoka, Japan
| | - Tomoko Hasegawa
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Shin Tanaka
- Department of Human, Information and Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan
| | - Kanako Hara
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan
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6
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Kassem A, Dahabra L, Abou Yassine A, Assaad M, Muhammad M, El-Sayegh D. Association Between Sarcoidosis and Risk of Venous Thromboembolism: A Retrospective Chart Review. Cureus 2022; 14:e25520. [PMID: 35800801 PMCID: PMC9245334 DOI: 10.7759/cureus.25520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Sarcoidosis is a multisystemic disorder of an unclear etiology. It has been postulated that sarcoidosis is a chronic autoimmune inflammation, which may predispose to venous thromboembolism (VTE). Recent studies showed increased VTE events in patients with sarcoidosis and other autoimmune disorders. This multicenter retrospective study aims at determining a possible correlation between VTE and sarcoidosis. Subjects and Method We reviewed charts from a commercial database (Explorys Inc, Cleveland, OH, USA), which is an aggregate of electronic health records from 26 major health care systems. We included patients between 30 and 69 of age. Patients with a condition known to cause a hypercoagulable state were excluded. We calculated the prevalence of VTE in patients with and without a diagnosis of sarcoidosis and compared the results. A multivariate analysis was performed to adjust for gender, race, age, tobacco use, and obesity. Results The overall prevalence of the VTE in patients without sarcoidosis was 1.4% compared to 4.9% in patients with sarcoidosis. Patients with sarcoidosis were more likely to develop VTE (OR: 2.96; 95% CI: 2.84-3.08; p < 0.001). Predictors of VTE in patients with sarcoidosis were gender, age, race, and obesity. Conclusion Our study indicates that sarcoidosis poses a risk of developing VTE. Further prospective studies are needed to shed light on this association and explain the prothrombotic phenotype of sarcoidosis.
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7
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Basida B, Haider MB, Barbosa J. Recurrent Unprovoked Deep Vein Thromboses in the Setting of Sarcoidosis. Cureus 2021; 13:e18528. [PMID: 34754680 PMCID: PMC8570122 DOI: 10.7759/cureus.18528] [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] [Accepted: 10/06/2021] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis is described as a state of immune-mediated chronic systemic inflammatory disease that is typically characterized by non-caseating granulomas. It involves multiple organs like the lungs, lymph nodes, eyes, skin, and liver. Besides the solid organ involvement, it is also known to be associated with various pro-thrombotic states leading to pulmonary embolism and deep vein thrombosis. Mechanical factors causing the venous stasis were considered the major contributing factors. However, based on recent studies, chronic inflammation from macrophages and activated leukocytes are also hypothesized to further activate thrombin and fibrin formation. Regardless of the etiology, the management focuses on life-long anticoagulation to prevent further episodes of thrombosis. Herein we present a case of a 38-year-old male with a history of sarcoidosis who was admitted after having recurrent deep vein thromboses. Further investigations revealed a negative hypercoagulable workup or other auto-immune processes and the absence of any granulomas causing mechanical compression on large vessel venous vasculature. He was adequately managed with anticoagulation therapy and followed up outpatient with no further similar episodes. This case adds to the growing understanding that the mechanisms by which sarcoidosis induces thromboembolism is primarily pro-inflammatory rather than mechanical in nature.
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Affiliation(s)
- Brinda Basida
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Maryam B Haider
- Internal Medicine, Detroit Medical Center, Wayne State University, Sinai-Grace Hospital, Detroit, USA
| | - Joshua Barbosa
- Kresge Eye Institute, Detroit Medical Center, Wayne State University, Detroit, USA
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Correlation between Potential Risk Factors and Pulmonary Embolism in Sarcoidosis Patients Timely Treated. J Clin Med 2021; 10:jcm10112462. [PMID: 34199396 PMCID: PMC8199598 DOI: 10.3390/jcm10112462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/21/2022] Open
Abstract
Background. Some studies with inconclusive results have reported a link between sarcoidosis and an increased risk of pulmonary embolism (PE). This study aimed at assessing a possible correlation between potential risk factors and PE in sarcoidosis patients. Methods. A total of 256 sarcoidosis patients (84 males and 172 females; mean age at diagnosis 49 ± 13) were enrolled after giving written informed consent. Clinical evaluations, laboratory and radiology tests were performed to evaluate the presence of pulmonary embolism. Results. Fifteen sarcoidosis patients with PE (4 males and 11 females; mean age at diagnosis 50 ± 11), diagnosed by lung scintigraphy and 241 sarcoidosis patients without PE (80 males and 161 females; mean age at diagnosis 47 ± 13), were observed. There was a statistically significant increase of the presence of antiphospholipid antibodies in the sarcoidosis group with pulmonary embolism. There was no statistically significant difference between the two groups as to smoking habit, obesity or hereditary thrombophilia frequency (p > 0.05, respectively). Conclusions. This study demonstrates a significant correlation between the presence of antiphospholipid antibody positivity and the pulmonary embolism events in our sarcoidosis patients. Furthermore, we propose screening for these antibodies and monitoring, aimed at timely treatment.
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Narula N, Iannuzzi M. Sarcoidosis: Pitfalls and Challenging Mimickers. Front Med (Lausanne) 2021; 7:594275. [PMID: 33505980 PMCID: PMC7829200 DOI: 10.3389/fmed.2020.594275] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology, may mimic other conditions at presentation often resulting in delayed diagnosis. These conditions include infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases. This review highlights the most common sarcoidosis mimics that often lead to pitfalls in diagnosis and delay in appropriate treatment. Prior to invasive testing and initiating immunosuppressants (commonly corticosteroids), it is important to exclude sarcoid mimickers.
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Affiliation(s)
- Naureen Narula
- Staten Island University Hospital, New York, NY, United States
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Arab TM, Decter ER, Ullah T, Thurm CA. Venous Thromboembolism and Sarcoidosis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1745-1749. [PMID: 31765366 PMCID: PMC6892390 DOI: 10.12659/ajcr.918346] [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] [Indexed: 11/28/2022]
Abstract
Patient: Male, 27 Final Diagnosis: Sarcoidosis Symptoms: Generalized body pain • productive cough • shortness of breath Medication: — Clinical Procedure: — Specialty: Pulmonology
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Affiliation(s)
- Talal M Arab
- Department of Pulmonology, Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Eva R Decter
- Stern College for Women, Yeshiva University, New York City, NY, USA
| | - Tofura Ullah
- Department of Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Craig A Thurm
- Department of Pulmonology, Jamaica Hospital Medical Center, Jamaica, NY, USA
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Parthvi R, Sikachi RR, Agrawal A, Adial A, Vulisha A, Khanijo S, Talwar A. Pulmonary hypertension associated with antiphospholipid antibody: Call for a screening tool? Intractable Rare Dis Res 2017; 6:163-171. [PMID: 28944137 PMCID: PMC5608925 DOI: 10.5582/irdr.2017.01044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Antiphospholipid (aPL) antibodies are antibodies specific for anionic phospholipids. They are immunoglobulins that attack phospholipids, phospholipid-binding proteins, or phospholipid-protein complexes and are detected in anticardiolipin and lupus anticoagulant assays. aPL antibodies are often associated with antiphospholipid syndrome (APS) which can be idiopathic or from secondary causes such as systemic lupus erythematosus (SLE), infection or drugs. They have also been shown to be associated with Pulmonary Hypertension. We conducted a review of the literature that included all articles on PubMed with keywords 'antiphospholipid antibody' and 'pulmonary hypertension' between January 1980 and July 2017 and identified 217 articles. A total of 47 articles were found to be relevant to the topic and included as references. We ascertained that aPL antibodies have been implicated in the development of both idiopathic pulmonary arterial hypertension (PAH) and PAH associated with connective tissue disease (CTD). aPL antibodies were also noted to be associated with left-sided valvular heart disease that can lead to pulmonary venous hypertension (PVH). Patients with anitiphospholipid antibody syndrome (Diagnostic criteria incudes +aPL antibodies) were noted to have a high risk of developing chronic thromboembolic pulmonary hypertension (CTEPH). A recent study also found a positive association of aPL antibodies with ILD and PH in patients with systemic sclerosis. While association between autoimmune thyroid disease and PH (Group V PH), and autoimmune thyroid disease and aPL antibodies is established, no studies linked these three phenomena together. Thus, aPL antibodies had an association with all WHO groups of Pulmonary hypertension (PH). In this review article, we study the association and discuss the need for screening for PH in patients with positive aPL antibodies.
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Affiliation(s)
- Rukma Parthvi
- Division of Internal Medicine Department, Northwell Health — Forest Hills Hospital, Forest Hills, NY, USA
| | - Rutuja R Sikachi
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Ajay Adial
- Division of Pulmonary, Critical Care & Sleep Medicine, New York Presbyterian Queens, NY, USA
| | - Abhinav Vulisha
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Sameer Khanijo
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Arunabh Talwar
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
- Feinstein Institute of Research, Northwell Health, Manhasset, NY, USA
- Address correspondence to: Dr. Arunabh Talwar, Division of Pulmonary, Critical Care & Sleep Medicine, Northwell Health, 410 Lakeville Rd., New Hyde Park, NY 11040, USA. E-mail:
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Tandon R, Baughman RP, Stanley J, Khan AA. The link between chronic thromboembolic pulmonary hypertension and sarcoidosis: association or visual masquerade? SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:352-355. [PMID: 32476868 DOI: 10.36141/svdld.v34i4.5852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 08/10/2017] [Indexed: 11/02/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) and sarcoidosis are recognized causes of pulmonary hypertension according to the World Health Organization classification scheme. This case series describes seven patients with sarcoidosis with a mean age of 61 who developed pulmonary hypertension. They were found to have CTEPH, diagnosed by either CT pulmonary angiography or a lung ventilation perfusion scan. They all underwent confirmatory right heart catheterization showing elevated mean pulmonary artery pressures (mean of 42 mmHg - normal less than 25 mmHg). Sarcoidosis has been previously shown to be associated with increased rates of venous thromboembolic disease. In these cases, patients with sarcoidosis later developed CTEPH and this may be another mechanism in which sarcoidosis can lead to pulmonary hypertension. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 352-355).
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Affiliation(s)
| | | | | | - Ali A Khan
- Rush University Medical Center, Pulmonary and Critical Care, Chicago, IL, USA
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13
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Geremek AG, Tomkowski W, Geremek M, Puścińska E, Małek G, Nowiński A, Bednarek M, Śliwiński P. Sarcoidosis as a risk factor for venous thromboembolism. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:170-178. [PMID: 32476839 DOI: 10.36141/svdld.v34i2.4911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/18/2016] [Indexed: 11/02/2022]
Abstract
Sarcoidosis as a chronic condition of immune dysregulation might be associated with increased risk of venous thromboembolism (VTE). In this study we report three cases of sarcoidosis and pulmonary embolism (PE) occurring together, that share common clinical, serological and pathological findings, confirming the diagnosis of active pulmonary sarcoidosis and no others co-existing prothrombotic factors. We hypothesized that the hypercoagulability and increased risk for VTE in sarcoidosis may be attributable to active local and generalized inflammatory process. The possible relation of clinical picture of sarcoidosis that favors thrombus formation and the bidirectional inflammation and coagulation process are discussed. Further investigation of PE in patients with sarcoidosis are required as the co-incidence of both diseases seems to be more frequent than expected. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 170-178).
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Affiliation(s)
- Anna Goljan Geremek
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Witold Tomkowski
- Cardio-pulmonary Intensive Care, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Marcin Geremek
- Department of Vascular Surgery, Wolski Hospital, Warsaw, Poland
| | - Elżbieta Puścińska
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Grzegorz Małek
- Department of Radiology and Diagnostic Imaging, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Adam Nowiński
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Michal Bednarek
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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14
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Ungprasert P, Crowson CS, Matteson EL. Association of Sarcoidosis With Increased Risk of VTE: A Population-Based Study, 1976 to 2013. Chest 2016; 151:425-430. [PMID: 27687848 DOI: 10.1016/j.chest.2016.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The goal of this study was to investigate the risk of VTE among patients with sarcoidosis. METHODS A cohort of 345 incident cases of sarcoidosis and 345 sex- and age-matched comparator subjects in Olmsted County, Minnesota, from 1976 to 2013 were identified from the comprehensive medical record linkage system. Medical records were reviewed for DVT and pulmonary embolism (PE). The cumulative incidence was estimated, adjusted for the competing risk of death. Cox proportional hazards models were used to compare the rate of development of these events between patients with sarcoidosis and the nonsarcoidosis comparison cohort. RESULTS The prevalence of VTE, DVT, and PE prior to the index date was not significantly different between case and comparator subjects. The risk of incident VTE adjusted for age, sex, and calendar year was significantly higher among patients with sarcoidosis (hazard ratio [HR], 3.04 [95% CI, 1.47-6.29]). Significantly elevated risk was observed in both subtypes of VTE, with an HR of 3.14 (95% CI, 1.32-7.48) for DVT and an HR of 4.29 (95% CI, 1.21-15.23) for PE. A sensitivity analysis including only VTE events that occurred at least 6 months after the index date adjusted for age, sex, and calendar year revealed somewhat lower HRs: VTE, 2.73 (95% CI, 1.30-5.72); DVT, 3.00 (95% CI, 1.25-7.20); and PE, 3.58 (95% CI, 0.98-13.03). CONCLUSIONS An increased risk of VTE among patients with sarcoidosis was observed in this population-based cohort.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN
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15
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Venous thromboembolism and sarcoidosis: co-incidence or coexistence? Cent Eur J Immunol 2016; 40:477-80. [PMID: 26862313 PMCID: PMC4737745 DOI: 10.5114/ceji.2015.56972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022] Open
Abstract
The association between venous thromboembolism (VTE) and sarcoidosis has been reported recently, nevertheless the true incidence of co-incident sarcoidosis and VTE is unknown. Sarcoidosis as a chronic disease of immune dysregulation might be associated with an increased risk of VTE. The mechanisms responsible for VTE development are not clear and may be influenced by several factors: activity of inflammation, clinical characteristics of sarcoidosis and comorbidities. Pulmonary embolism (PE) as a potentially fatal condition should be considered in all of the patients with sarcoidosis in whom worsening of the respiratory status is diagnosed. A high plasma D-dimers (DD) level may be suggestive of VTE, nevertheless elevated plasma DD should be interpreted with caution, in the context of the active inflammatory process. If sarcoidosis appears to be one of risk factors for VTE development, further investigations are needed to define the pro-thrombotic phenotype of this disease.
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16
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Pathak R, Khanal R, Aryal MR, Giri S, Karmacharya P, Pathak B, Acharya U, Bhatt VR. Sarcoidosis and Antiphospholipid Syndrome: A Systematic Review of Cases. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:379-83. [PMID: 26605200 PMCID: PMC4630729 DOI: 10.4103/1947-2714.166213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Association between sarcoidosis and antiphospholipid syndrome (APS) is rare with few reported cases. We sought to systematically review the published cases of APS with sarcoidosis to better characterize the demographics, clinical characteristics, treatment, and the outcome of this association. Systematic electronic search for case report, case series, and related articles published until May 2014 was carried out and relevant data were extracted and analyzed. Four cases of APS with sarcoidosis were identified exclusively in females. These cases were seen in the sixth decade of life. Pulmonary embolism and central retinal artery occlusion were the presenting thrombotic events. All the patients were treated with lifelong anticoagulation with warfarin. During the median follow-up period of 5.5 months, additional thrombotic events were not observed. Although rare, sarcoidosis may be associated with APS. Further reporting of the cases will help to better establish this association, elucidate pathogenesis, and define clinical characteristics and outcomes.
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Affiliation(s)
- Ranjan Pathak
- Department of Internal Medicine, Reading Health System, Pennsylvania, USA
| | - Raju Khanal
- Department of Internal Medicine, Reading Health System, Pennsylvania, USA
| | - Madan Raj Aryal
- Department of Internal Medicine, Reading Health System, Pennsylvania, USA
| | - Smith Giri
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paras Karmacharya
- Department of Internal Medicine, Reading Health System, Pennsylvania, USA
| | - Basanta Pathak
- Department of Internal Medicine, Rapid City Regional Hospital, Rapid City, South Dakota, USA
| | - Upasana Acharya
- Department of Oral Medicine, College of Dental Sciences, Kathmandu, Nepal
| | - Vijaya Raj Bhatt
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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17
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Curimbaba J, Pimenta J, Moreira JM, Carla Sousa Rodrigues U, Coletta ENA, Pereira CAC. Sarcoidosis Masquerading as Atrial Fibrillation: Interesting Case Discussion as Well as Recent Advances in Diagnosis and Management of Cardiac Sarcoidosis. J Atr Fibrillation 2012; 5:533. [PMID: 28496787 DOI: 10.4022/jafib.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 04/10/2012] [Accepted: 08/18/2012] [Indexed: 11/10/2022]
Abstract
This report presents a case of cardiac sarcoidosis initially manifested with atrial fibrillation. This behavior is very uncommon in spite of the fact that the disease is multisystemic, affecting predominantly the lungs. It is emphasized that the diagnosis of the cardiac involvement is difficult, and when this occurs, can lead to conducting system disturbances, heart failure or sudden death (SD). The diagnosis can be made by evaluating the clinical manifestations, the noninvasive tests like ECG, Holter monitoring, chest radiography, thoracic computed tomography, magnetic resonance image and positron emission tomography. In general, sarcoidosis is treated with steroid compounds with good outcome, mainly when performed in the initial phases of the disease. Other cardiac manifestations, such as arrhythmias, atrioventricular block or heart failure, are managed similar to other cardiomyopathies.
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Affiliation(s)
- Jefferson Curimbaba
- Coordinator of the Cardiology Clinic, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
| | - João Pimenta
- Director of the Cardiology Service, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
| | - José Marcos Moreira
- Coordinator of the Holter Section, Cardiology Service, Hospital do Servidor Públicoo Estadual, São Paulo, SP, Brazil
| | | | | | - Carlos A C Pereira
- Director of the Pneumology Service, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil, From the Cardiology and Pneumology Services, Hospital do Servidor Publico Estadual, São Paulo, SP, Brazil
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18
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Nunes H, Uzunhan Y, Freynet O, Humbert M, Brillet PY, Kambouchner M, Valeyre D. Pulmonary hypertension complicating sarcoidosis. Presse Med 2012; 41:e303-16. [DOI: 10.1016/j.lpm.2012.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/11/2012] [Indexed: 11/16/2022] Open
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19
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Mahévas M, Chiche L, Uzunhan Y, Khellaf M, Morin AS, Le Guenno G, Péronne V, Affo L, Lidove O, Boutboul D, Dion G, Ducroix JP, Papo T, Pacheco Y, Schleinitz N, Michel M, Godeau B, Valeyre D. Association of sarcoidosis and immune thrombocytopenia: presentation and outcome in a series of 20 patients. Medicine (Baltimore) 2011; 90:269-278. [PMID: 21694642 DOI: 10.1097/md.0b013e31822618b3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The association of sarcoidosis and immune thrombocytopenia (ITP) has rarely been investigated. The aim of the current retrospective study was to investigate the clinical and biological phenotypes and outcome of this association in a large series of recent patients. Twenty patients (50% men) were included. Median age at sarcoidosis and ITP diagnosis was 36 (range, 10-83 yr) and 38 (range, 21-83 yr) years, respectively. In 11 of 20 (55%) patients, sarcoidosis onset preceded ITP (median interval, 48 mo; range, 6-216 mo). In 5 of 20 (25%) patients, the 2 conditions occurred concomitantly. In 4 of 20 (20%) patients, ITP onset preceded sarcoidosis (median interval, 68 mo; range, 15-153 mo). In 4 cases, sarcoidosis and ITP were not concomitant, since 1 condition was cured before the other was declared. In 12 of 20 (60%) patients there was a simultaneous onset or relapse of both ITP and sarcoidosis. Sarcoidosis phenotype was characterized by an acute onset in 40% of patients. The visceral involvement included thoracic sites in 19 of 20 (95%) patients and extrathoracic sites in 16 of 20 (80%) patients. At ITP onset, median platelet count was 11 × 10/L (range, 3-90); 17 (85%) patients had a platelet count <30 × 10/L. Seven (35%) patients had a bleeding score >8 without visceral bleeding.Nineteen of the 20 (95%) patients were treated specifically for ITP. After the first-line therapy (prednisone at 1 mg/kg per day for at least 3 consecutive weeks in all patients; with IVIg in addition for 10 patients with severe bleeding score), 12 of 19 (63%) patients achieved a complete response, 6 (31.5%) had a partial response, and only 1 patient failed to respond. At the end of ITP follow-up (median, 70 mo; range, 12-142 mo), 18 (90%) patients achieved a complete response, 1 achieved a partial response, and 1 had no response. After a median follow-up of 105 months, 13 of 20 (65%) patients had persistent sarcoidosis requiring prolonged therapy, and thus sarcoidosis represented the main long-term concern. Main conclusions were 1) ITP presentation was usually severe, but response to treatment was favorable in almost all cases, with no death and no severe bleeding, in contrast with older reports, 2) sarcoidosis was remarkable for the high proportion of cases with an acute onset, a chronic course, and the need for prolonged prednisone therapy, 3) sarcoidosis and ITP onset and evolution were not always synchronous.
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Affiliation(s)
- Matthieu Mahévas
- From Department of Internal Medicine-Centre de référence des cytopénies auto-immunes de l'adulte (M. Mahévas, MK, M. Michel, BG), Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Paris XII University, Créteil; Groupe Sarcoidose Francophone (M. Mahévas, YU, GD, JPD, YP, BG, DV), SPLF, Maison du poumon, Paris; Department of Internal Medicine (LC, NS), Hôpital de la Conception, Marseille; Université Paris 13, EA2363 and Avicenne Hospital, Department of Pneumology (YU, GD, DV), Assistance Publique Hôpitaux de Paris, Bobigny; Department of Internal Medicine (ASM), Jean-Verdier Hospital, Bondy; Departement of Internal Medicine (GLG), Clermont Ferrand Hospital, Clermont Ferrand; Department of Internal Medicine (VP), François Quesnay Hospital, Mantes la Jolie; Department of Internal Medicine(LA), Louis Mourier Hospital, Assistance Publique Hôpitaux de Paris, Colombes; Department of Internal Medicine (OL, TP), Bichat Hospital, Assistance Publique Hôpitaux de Paris, Claude Bernard, Paris; EA 3963, Centre Hayem, Saint-Louis Hospital (DB), Assistance Publique Hôpitaux de Paris, Paris; Department of Internal Medicine (JPD), Amiens Nord Hospital, Jules Verne University, Amiens; Department of Pneumology (YP), Lyon Hospital, Université Lyon sud, Lyon; France
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20
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Wesemann DR, Costenbader KH, Coblyn JS. Co-existing sarcoidosis, systemic lupus erythematosus and the antiphospholipid antibody syndrome: case reports and discussion from the Brigham and Women's Hospital Lupus Center. Lupus 2009; 18:202-5. [PMID: 19213857 DOI: 10.1177/0961203308100483] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcoidosis, systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS) are chronic conditions of immune dysregulation whose aetiologies remain mysterious. Expression of sarcoidosis and SLE within individuals has been reported in a handful of cases in the last 60 years. In this study, we report two cases of sarcoidosis and SLE occurring together, and each case demonstrated complications associated with the presence of anticardiolipin antibodies. Clinical, serological and pathological findings confirmed the diagnoses in each case and both patients improved with therapy. The association of sarcoidosis, SLE and APS is unique and may present difficult therapeutic options, as well as to shed light on their immunopathogenesis.
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Affiliation(s)
- D R Wesemann
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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21
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Marc K, Bourkadi JE, Benamor J, Iraqi G. [Thoracic venous thrombosis in the course of sarcoidosis]. Rev Mal Respir 2008; 25:105-6. [PMID: 18288062 DOI: 10.1016/s0761-8425(08)70477-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- K Marc
- Service de Pneumologie, Hôpital Moulay Youssef, CHU Ibn Sina, Rabat, Morocco.
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22
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Takahashi F, Toba M, Takahashi K, Tominaga S, Sato K, Morio Y, Nakao Y, Tajima K, Miura K, Uekusa T, Fukuchi Y. Pulmonary sarcoidosis and antiphospholipid syndrome. Respirology 2006; 11:506-8. [PMID: 16771926 DOI: 10.1111/j.1440-1843.2006.00880.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Various autoimmune diseases have been reported to occur in patients with sarcoidosis. However, coexistence of sarcoidosis and antiphospholipid syndrome (APS) is extremely rare. We describe a 59-year-old female patient with pulmonary sarcoidosis who had preceding APS. Her previous medical history consisted of a miscarriage and ischemic colitis. She was diagnosed as APS during the onset of a brainstem infarction with positive reaction to beta2-glycoprotein I-dependent anticardiolipin antibody. Two years later, chest CT revealed enlargement of the hilar and mediastinal lymph nodes and small nodules in the lung fields. Transbronchial lung biopsy demonstrated non-caseating epithelioid cell granuloma leading to the diagnosis of definite pulmonary sarcoidosis. This is the first APS case where pulmonary involvement with sarcoidosis has been confirmed through lung biopsy. Our case report suggests that APS should be recognized as an accompanying disorder of sarcoidosis.
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Affiliation(s)
- Fumiyuki Takahashi
- Department of Respiratory Medicine, Juntendo University, School of Medicine, Hongo, Tokyo, Japan.
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23
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Esen BA, Kıyan E, Küçükkaya RD, Tabak L, Aktürk F, Arseven O, Okumuş G, İnanç M. Antiphospholipid Syndrome Presenting As Massive Pulmonary Embolism in a Patient With Sarcoidosis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2005. [DOI: 10.29333/ejgm/82338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Abstract
We report the case of a 72-year-old female with sarcoidosis who developed a central retinal artery occlusion in her left eye in association with persistently high titers of IgG anti-cardiolipin antibodies. Only two previous cases of antiphospholipid antibody syndrome in association with sarcoidosis have been reported. Our patient's vision stabilized on anti-coagulant therapy along with concomitant treatment of sarcoidosis-related uveitis with methotrexate.
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Affiliation(s)
- R Singh
- Section of Rheumatology, LSU Health Sciences Center, New Orleans, Louisiana, USA
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25
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López García-Gallo C, Ussetti P, Díaz B, de Pablo A, Laporta R. [Pulmonary sarcoidosis and antiphospholipid syndrome]. Arch Bronconeumol 2003; 39:187-9. [PMID: 12716562 DOI: 10.1016/s0300-2896(03)75356-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pulmonary sarcoidosis is an idiopathic granulomatosis with a clinical picture involving dyspnea, coughing, chest pain and characteristic radiologic changes. A review of English and Spanish language publications (PubMed 1990 through 2002) suggests that our report of a case of pulmonary sarcoidosis associated with primary antiphospholipid syndrome is the first one in the literature for this period. The patient was a 35-year-old man with venous thrombosis who later developed pulmonary sarcoidosis. The clinical course was not favorable in spite of good prognostic factors. We conclude that the association of these two clinical conditions is rare and that the presence of antiphospholipid syndrome may lead to greater morbidity and mortality.
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Abstract
Sarcoidosis is one in a heterogeneous family of granulomatous disorders. The clinical manifestations of sarcoidosis can vary widely, depending on the patient and the tissues involved. Recent advances in our understanding of the immunologic steps leading to granuloma formation and persistence have yet to translate into more effective care for patients with this disease. This review discusses the immunology of granuloma formation and systemic disease, the various nonpulmonary expressions of the clinical disease, and the treatment options available to the practicing physician.
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Affiliation(s)
- Stephen J Oliver
- Laboratory of Cellular Physiology & Immunology, Rockefeller University, 1230 York Avenue, New York, NY 10021, USA.
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27
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Dumas JL, Valeyre D, Chapelon-Abric C, Belin C, Piette JC, Tandjaoui-Lambiotte H, Brauner M, Goldlust D. Central nervous system sarcoidosis: follow-up at MR imaging during steroid therapy. Radiology 2000; 214:411-20. [PMID: 10671588 DOI: 10.1148/radiology.214.2.r00fe05411] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To document the changes observed at sequential magnetic resonance (MR) imaging of sarcoidosis lesions of the central nervous system (CNS) during treatment with corticosteroids. MATERIALS AND METHODS The abnormalities detected in 24 patients (mean follow-up, 36 months) were compared before and after therapeutic periods (n = 75) that were divided into attack (high-dose), upkeep (decreased-dose), and minimal (low-dose) periods. Parenchymal lesions were classified as type 1 (enhanced with gadolinium), type 2 (demyelinating), or type 3 (lacunar) and were assessed as regressing, stable, or progressing. RESULTS Seven of the 24 patients had several types of lesions. Isolated type 3 lesions (six patients) were the only lesions not associated with neurologic deficit. Type 1 lesions (13 patients) regressed in 22 of 22 attack periods and progressed in nine of 27 upkeep and minimal periods. MR imaging depicted relapses in patients with multifocal CNS involvement or long-standing CNS impairment or in those who had previously received steroid therapy. Type 2 (seven patients) and type 3 (13 patients) lesions remained stable in 68 of 68 therapeutic periods. Type 1 lesions appeared in three patients with type 2 and type 3 lesions during two upkeep and three minimal periods. Findings at follow-up MR imaging contributed to the reintroduction of high-dose corticosteroid therapy in eight patients. CONCLUSION MR imaging can be used to differentiate between reversible and irreversible lesions in CNS sarcoidosis. MR imaging can be a useful tool for adjusting treatment to prevent irreversible CNS damage.
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Affiliation(s)
- J L Dumas
- Department of Radiology, Hôpital Avicenne, 125 route de Stalingrad, 93009 Bobigny, France
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Satti SD, Bartholomew J, Gordon SM, Longworth DL, Adal KA. Antiphospholipid antibody syndrome in a patient with neurosarcoidosis. Vasc Med 1999; 4:37-9. [PMID: 10355869 DOI: 10.1177/1358836x9900400107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The case of a 56-year-old woman who developed neurosarcoidosis and was discovered to have inferior vena cava and lower extremity thromboses is described. She was found to have anticardiolipin antibodies. This newly described association of antiphospholipid antibody syndrome with sarcoidosis is discussed and the relevant literature reviewed.
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Affiliation(s)
- S D Satti
- Department of Internal Medicine, The Cleveland Clinic Foundation, OH 44195, USA
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29
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Piette JC, Amoura Z, Wechsler B, Frances C. [Neurological manifestations of antiphospholipid syndrome]. Rev Med Interne 1998; 19 Suppl 1:39S-45S. [PMID: 9789526 DOI: 10.1016/s0248-8663(98)80028-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- J C Piette
- Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, Paris, France
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30
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Chapelon Abric C, Ginsburg C, Biousse V, Wechsler B, de Gennes C, Darbois Y, Janse Marec J, Godeau P, Piette JC. [Sarcoidosis and pregnancy. A retrospective study of 11 cases]. Rev Med Interne 1998; 19:305-12. [PMID: 9775163 DOI: 10.1016/s0248-8663(98)80099-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze the evolutive profile of sarcoidosis together with reciprocal interactions between pregnancy and sarcoidosis. METHODS All events that occurred during pregnancy in 11 women presenting with sarcoidosis were analyzed. Histological confirmation was obtained for the 11 cases. For all pregnancies were analyzed the course of both sarcoidosis and pregnancy, and the influence of pregnancy on the disease evolution. RESULTS Among 33 pregnancies, 23 led to the birth of healthy fetuses (five spontaneous abortions, four voluntary abortions, and one therapeutic abortion). The major event was fetal hypotrophy in six cases. Three of them occurred during pregnancy in prednisone-treated patients with active sarcoidosis. No relapse of cured sarcoidosis or further evolution of sarcoidosis that was inactivated as of the beginning of pregnancy were observed. The course of active sarcoidosis varied, as improvement (one case), worsening (two cases) and stabilization (two cases) were observed. During the first year of follow-up after delivery, four relapses and, in two cases, preliminary signs of the disease were observed. CONCLUSION Apart from the hypothetical but not definite risk of hypotrophy, no negative interaction between sarcoidosis and pregnancy could be established. Pregnancy does not seem to interfere with the course of sarcoidosis. Considering the risk of relapse after delivery, pregnant women presenting with sarcoidosis should benefit from clinical and radiological follow-up.
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Affiliation(s)
- C Chapelon Abric
- Service de médecine interne, Hôpital de la Pitié-Salpêtrière, Paris, France
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Manfredi AA, Rovere P, Galati G, Heltai S, Bozzolo E, Soldini L, Davoust J, Balestrieri G, Tincani A, Sabbadini MG. Apoptotic cell clearance in systemic lupus erythematosus. I. Opsonization by antiphospholipid antibodies. ARTHRITIS AND RHEUMATISM 1998; 41:205-14. [PMID: 9485078 DOI: 10.1002/1529-0131(199802)41:2<205::aid-art4>3.0.co;2-0] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To verify whether antiphospholipid antibodies (aPL) recognize and opsonize apoptotic human cells. METHODS Apoptosis was induced via CD95 crosslinking or ultraviolet irradiation. IgG and anti-beta2-glycoprotein I (anti-beta2-GPI) antibodies were purified from patient sera by affinity chromatography. The aPL that bound to apoptotic cells were assessed by flow cytometry, and the subdomains recognized were identified by confocal microscopy. Human macrophages were derived from monocytes, and their ability to phagocytose 3H-labeled apoptotic bodies, whether opsonized or not opsonized by aPL, was assessed. Tumor necrosis factor alpha (TNF alpha) secretion was evaluated by enzyme-linked immunosorbent assay. RESULTS The aPL, but not control Ig or Ig from aPL-negative patients, bound to apoptotic cells, but not to viable cells. Nuclear antigens were not recognized. Opsonization of apoptotic cells by aPL substantially enhanced recognition and binding by scavenger macrophages, with massive TNF alpha secretion. CONCLUSION Antiphospholipid antibodies facilitate apoptotic cell clearance by macrophages and trigger TNF alpha release, possibly enhancing the immunogenicity of the autoantigens they contain.
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Affiliation(s)
- A A Manfredi
- Istituto Scientifico H. S. Raffaele and Università di Milano, Milan, Italy
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Papadopoulos KI, Jönsson A, Berntorp E, Törnquist C, Hulthén UL. Primary antiphospholipid syndrome associated with postoperative primary adrenal failure. J Intern Med 1995; 238:175-8. [PMID: 7629486 DOI: 10.1111/j.1365-2796.1995.tb00916.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 51-year-old Caucasian male without previous history of thromboembolic disease developed Coomb's positive haemolytic anaemia, thrombocytopenia, transient paranoid psychosis and bilateral adrenal haemorrhage with primary adrenal failure after surgery for inguinal hernia. The activated partial thromboplastin time was spontaneously prolonged, and lupus anticoagulant and anticardiolipin antibodies were detected. In the absence of criteria for classification of systemic lupus erythematosus (SLE), the entity was classified as a primary antiphospholipid syndrome. Despite the persistence of the serological abnormalities, the patient remains well after substitution with cortisone. Primary adrenal failure due to adrenal haemorrhage can be associated with the primary antiphospholipid syndrome.
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Affiliation(s)
- K I Papadopoulos
- Department of Endocrinology, Lund University Clinics, General Hospital, Malmö, Sweden
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