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Rahmanian E, Alikhani M, Loghman M, Beikmohamadi Hezaveh S, Zangeneh S, Shahriarirad R, Faezi ST, Nejadhosseinian M. COVID
‐19
vaccine‐induced
vasculitis in a patient with sarcoidosis: A case report. Clin Case Rep 2022; 10:e6501. [DOI: 10.1002/ccr3.6501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Ehsan Rahmanian
- Department of Rheumatology Hormozgan University of Medical Sciences Bandar Abbas Iran
| | - Majid Alikhani
- Department of Internal Medicine, School of Medicine, Rheumatology Research Center, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Maryam Loghman
- Department of Internal Medicine, School of Medicine, Rheumatology Research Center, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Sara Beikmohamadi Hezaveh
- Resident of Neurology, Department of Neurology, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Saba Zangeneh
- School of Medicine Fasa University of Medical Sciences Shiraz Iran
| | - Reza Shahriarirad
- School of Medicine Shiraz University of Medical Sciences Shiraz Iran
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Seyedeh Tahereh Faezi
- Department of Internal Medicine, School of Medicine, Rheumatology Research Center, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Mohammad Nejadhosseinian
- Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran
- Rheumatology Research Center Tehran University of Medical Sciences Tehran Iran
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Hasbani GE, Uthman I, Jawad AS. Musculoskeletal Manifestations of Sarcoidosis. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441211072475. [PMID: 35185345 PMCID: PMC8854226 DOI: 10.1177/11795441211072475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 01/12/2023]
Abstract
Since its initial description in the late 19th century, sarcoidosis has been extensively studied. Although the general mechanism of immune activation is known, many details especially in the context of disease associations are still missing. One of such associations is the musculoskeletal complications that are widely variable in terms of presentation and response to treatment. Sarcoidosis can involve the joints leading to acute and, less commonly chronic, arthritis. While acute arthritis is mostly self-resolving in nature, chronic arthritis may lead to deformity and destruction of the joint. Sarcoidosis can also involve the muscles, leading to different pathologies primarily categorized according to the clinical presentation, despite the efforts to find a new classification based on imaging, histological, and clinical findings. The bones can be directly and indirectly affected. Different types of bone lesions have been described, although around half of these patients remain asymptomatic. Osteoporosis, increased risk of fractures, hypercalcemia, and hypercalciuria are examples of the indirect effect of sarcoidosis on the bones, possibly contributed to elevated levels of calcitriol. Nevertheless, sarcoidosis can be associated with small-vessel, medium-vessel, and large vessel vasculitis, although it is frequently difficult to differentiate between the co-existence of a pure vasculitis and sarcoidosis and sarcoid vasculitis.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Sm Jawad
- Department of Rheumatology, The Royal London Hospital, London, UK
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Zhang H, Kong F, Yu F, Hao S. First report of rheumatoid arthritis and secondary Sjögren's syndrome complicated with heart failure. Clin Case Rep 2021; 9:e04581. [PMID: 34401161 PMCID: PMC8357077 DOI: 10.1002/ccr3.4581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
A 70-year-old woman with rheumatoid arthritis for 45 years developed secondary Sjögren's syndrome. She had a long-term low-salt and low-fat diet and did not adhere to long-term hormone and rheumatic immunotherapy, which led to heart failure.
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Affiliation(s)
- Hui Zhang
- Department of GastroenterologyDalian Central HospitalDalianChina
- Department of OtolaryngologyFirst Affiliated Hospital of China Medical UniversityShenyangChina
| | - Fanxue Kong
- Department of OphthalmologyFirst Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Fei Yu
- School of Public HealthChina Medical UniversityShenyangChina
- School of Public HealthHe UniversityShenyangChina
| | - Shuai Hao
- Department of OtolaryngologyFirst Affiliated Hospital of China Medical UniversityShenyangChina
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Kaufman KP, Becker ML. Distinguishing Blau Syndrome from Systemic Sarcoidosis. Curr Allergy Asthma Rep 2021; 21:10. [PMID: 33560445 DOI: 10.1007/s11882-021-00991-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a framework to distinguish Blau syndrome/Early Onset Sarcoidosis and Sarcoidosis clinically. We also discuss relevant differences in genetics, pathogenesis, and management of these diseases. RECENT FINDINGS Blau syndrome and Sarcoidosis share the characteristic histologic finding of noncaseating granulomas as well as some similar clinical characteristics; nevertheless, they are distinct entities with important differences between them. Blau syndrome and Early Onset Sarcoidosis are due to one of numerous possible gain-of-function mutations in NOD2, commonly presenting before age 5 with a triad of skin rash, arthritis, and uveitis. However, as more cases are reported, expanded clinical manifestations have been described. In systemic Sarcoidosis, there are numerous susceptibility genes that have been identified, and disease is thought to result from an environmental exposure in a genetically susceptible host. It most often presents with constitutional symptoms and pulmonary involvement and typically affects adolescents and adults. This paper reviews the similarities and differences between Blau syndrome and Sarcoidosis. We also discuss the importance of distinguishing between them, particularly with regard to prognosis and outcomes.
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Affiliation(s)
- Katherine P Kaufman
- Department of Pediatrics, Division of Rheumatology and Nephrology, Duke University Medical Center, Durham, NC, USA.
- CarolinaEast Internal Medicine, Pollocksville, NC, USA.
| | - Mara L Becker
- Department of Pediatrics, Division of Rheumatology and Nephrology, Duke University Medical Center, Durham, NC, USA
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Gendelman HK, Sabha M, Gryaznov AA, Siaton BC. Recurrent Syncope Due to Concurrent Cardiac Sarcoidosis and Large-Vessel Vasculitis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927331. [PMID: 33510124 PMCID: PMC7851718 DOI: 10.12659/ajcr.927331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient: Male, 68-year-old Final Diagnosis: Sarcoidosis • vasculitis Symptoms: Syncope Medication:— Clinical Procedure: — Specialty: Rheumatology
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Affiliation(s)
- Hannah K Gendelman
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marwa Sabha
- Division of Rheumatology, Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anton A Gryaznov
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bernadette C Siaton
- Division of Rheumatology, Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Kang K, Sun Y, Li YL, Chang B. Pathogenesis of liver injury in Takayasu arteritis: advanced understanding leads to new horizons. J Int Med Res 2020; 48:300060520972222. [PMID: 33275473 PMCID: PMC7720339 DOI: 10.1177/0300060520972222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Liver injury in Takayasu arteritis (TA) is a rare phenomenon. Most symptoms are nonspecific, and the exact pathogenesis remains to be elucidated. Early diagnosis and new treatment methods are important for an improved prognosis. A summary of the clinical information and mechanistic analyses may contribute to making an early diagnosis and development of new treatment methods. A PubMed search was conducted using the specific key words “Takayasu arteritis” and “liver” or “hepatitis” or “hepatic”. Symptoms and treatment of TA with an accompanying liver injury were reviewed retrospectively. Many factors are presumed to be involved in the mechanism of TA with liver injury, including the immune response, genes, infections, and gut microbiota. There are several lines of evidence indicating that immune dysfunction is the main pathogenic factor that triggers granuloma formation in TA patients. However, the role of genetics and infections has not been fully confirmed. Recently, the gut microbiota has emerged as an essential component in the process. We reviewed in detail the current concepts that support the complex pathogenesis of TA accompanied by liver injury, and we presented recent theories from the literature. Finally, we discussed future research directions of liver injury in TA.
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Affiliation(s)
- Kai Kang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yue Sun
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yi Ling Li
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Bing Chang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
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Poudel J, Risal U, Sigdel KR, Paudyal BP, Adhikari S, Basnyat B. Case Report: Co-existence of sarcoidosis and Takayasu arteritis. Wellcome Open Res 2020; 5:73. [PMID: 32885051 PMCID: PMC7450474 DOI: 10.12688/wellcomeopenres.15837.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 11/20/2022] Open
Abstract
Takayasu arteritis is a rare systemic large vessel vasculitis affecting the aorta and its branches. Sarcoidosis, too, is an inflammatory disease. Both entities are granulomatous conditions with a questionable association in their etiopathogenesis. Only a few cases of their coexistence have been reported in the literature. To our knowledge, no such cases have been reported from Nepal. We report a Nepalese woman who presented with non-productive cough, progressive shortness of breath and chest tightness of 3 years duration. She had a history of recurrent bilateral granulomatous uveitis over the previous 3 years. Examination revealed clubbing of digits, absent pulses over the left radial, ulnar and brachial arteries, and a weak pulse over the right arm including the bilateral carotid arteries. Pulmonary function test showed restrictive pattern, a high-resolution computed tomography (HRCT) scan of the chest revealed findings suggestive of pulmonary sarcoidosis. A CT angiogram suggested large vessel vasculitis. Bronchoscopy with biopsy revealed granulomatous inflammation, negative for malignancy and tuberculosis. She was hence, diagnosed with co-existing Takayasu arteritis and sarcoidosis, and treated with Prednisolone 60 mg once daily with dramatic improvement over 4 days and was discharged stable on domiciliary oxygen. She is currently on azathioprine 50 mg, prednisolone 10 mg without the need for supplemental oxygen. This case report highlights the importance of a proper physical examination as a guide to the use of modern technology in making a correct diagnosis. Furthermore, in countries where tuberculosis is endemic, it should always come as the most important differential diagnosis of granulomatous inflammation.
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Affiliation(s)
- Jiwan Poudel
- Internal Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujjwol Risal
- Internal Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Keshav Raj Sigdel
- Internal Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Sudeep Adhikari
- Internal Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Buddha Basnyat
- Internal Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal.,Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
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