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Bert A, Gilbert T, Cottin V, Mercier J, Gerfaud-Valentin M, Durieu I, Hot A, Hicks J, Varron L, Seve P, Jamilloux Y. Sarcoidosis diagnosed in the elderly: a case-control study. QJM 2021; 114:238-245. [PMID: 32569362 DOI: 10.1093/qjmed/hcaa171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 04/18/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Studies on sarcoidosis in elderly patients are scarce and none have specifically evaluated patients aged ≥75 at onset. AIM We aimed to analyse the characteristics of patients with sarcoidosis diagnosed after 75 and to compare them with those of younger patients. DESIGN Multicenter case-control study comparing elderly-onset sarcoidosis (EOS) with young-onset sarcoidosis (YOS) seen at Lyon University Hospitals between 2006 and 2018. METHODS Using our institutional database, we included 34 patients in the EOS group and compared them with 102 controls from the YOS group in a 1:3 ratio. Demographic characteristics, medical history, clinical presentation, laboratory and imaging findings, sites of biopsies, histological analyses, treatments and outcomes were recorded using a comprehensive questionnaire. RESULTS There were more Caucasians in the EOS group (94.1% vs. 59.8%; P < 0.001), who had significantly more comorbidities (mean, 3.1 ± 2 vs. 1.1 ± 1.6; P < 0.001). In the EOS group, there was less pulmonary involvement (26.5% vs. 49%; P = 0.022), less lymphadenopathy (2.9% vs. 16.7%; P = 0.041), no erythema nodosum (0% vs. 12.8%; P = 0.029) and no arthralgia (0% vs. 25.5%; P = 0.001). Conversely, uveitis was more common in the EOS group (55.9% vs. 20.6%; P < 0.001). Pathological confirmation was obtained significantly less frequently in the EOS group (67.7% vs. 85.3%; P = 0.023). Corticosteroid-related side effects were significantly more common in the EOS group (100% vs. 75.9%; P = 0.030). CONCLUSION Epidemiology and clinical presentation of EOS differs from YOS, including more comorbidities and more uveitis. Elderly patients are more prone to corticosteroid side effects.
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Affiliation(s)
- A Bert
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - T Gilbert
- Short Stay Geriatric Unit, Lyon Sud University Hospital, University Claude Bernard University Lyon 1, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - V Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel University Hospital, University Claude Bernard University Lyon 1, 59 Boulevard Pinel, 69500 Bron, France
| | - J Mercier
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - M Gerfaud-Valentin
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - I Durieu
- Department of Internal Medicine, Lyon Sud University Hospital, University Claude Bernard University Lyon 1, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - A Hot
- Department of Internal Medicine, Edouard Herriot University Hospital, University Claude Bernard University Lyon 1, 5 Place d'Arsonval, 69003 Lyon, France
| | - J Hicks
- Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - L Varron
- Department of Internal Medicine, Montélimar Hospital, Quartier Beausseret, Route de Sauzet, 26200 Montélimar, France
| | - P Seve
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Y Jamilloux
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
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Peter E, Jean-Baptiste F, Harbaoui B, Kone-Paut I, Dauphin C, Gomard-Mennesson E, Hervier B, De Boysson H, Varron L, Pugnet G, Gobert D, Bachmeyer C, Humbert S, Roblot P, Cathébras P, Gerfaud-Valentin M, Weber E, Jamilloux Y, Fain O, Sève P. Devenir cardiovasculaire à long terme dans la maladie de Kawasaki de l’adulte. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Roussotte M, Gerfaud-Valentin M, Lega J, Thibault T, Lobbes H, Goulabchand R, Cathébras P, Varron L, Dufour J, Deroux A, Le Guenno G, Compain C, Baudet A, Karkowski L, Perard L, Ebbo M, Hot A, Sève P. Traitement de la thrombopénie immunologique cliniquement significative secondaire au lupus érythémateux systémique : étude rétrospective de 90 patients en vie réelle. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roussotte M, Gerfaud-Valentin M, Lega J, Audia S, Ruivard M, Goulabchand R, Cathébras P, Varron L, Dufour J, Alban D, Le Guenno G, Compain C, Baudet A, Karkowski L, Perard L, Hot A, Sève P. Thrombopénie immunologique cliniquement significative secondaire au lupus érythémateux systémique : description d’une cohorte rétrospective de 74 cas. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Leal C, Le Roux K, Rahmi A, Varron L, Broussolle C, Denis P, Kodjikian L, Sève P. Sclérites, aspects cliniques, étiologiques et thérapeutiques : à propos d’une série de 32 observations. Rev Med Interne 2014; 35:491-7. [DOI: 10.1016/j.revmed.2013.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 07/24/2013] [Accepted: 09/23/2013] [Indexed: 11/17/2022]
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Jamilloux Y, Neel A, Lecouffe-Desprets M, Fevre A, Kerever S, Guillon B, Bouvry D, Varron L, Redares C, Dominique S, Roux M, Chapelon-Abric C, Valeyre D, Ducray F, Bernard C, Broussolle C, Hamidou M, Seve P. Progressive multifocal leukoencephalopathy in patients with sarcoidosis. Neurology 2014; 82:1307-13. [DOI: 10.1212/wnl.0000000000000318] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jamilloux Y, Néel A, Lecouffe-Desprets M, Fèvre A, Kerever S, Guillon B, Bouvry D, Varron L, Dominique S, Bernard C, Broussolle C, Seve P. Leucoencéphalopathie multifocale progressive au cours de la sarcoïdose. À propos de dix cas. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bernard C, Maucort-Boulch D, Varron L, Charlier C, Sitbon K, Freymond N, Bouhour D, Hot A, Masquelet AC, Valeyre D, Costedoat-Chalumeau N, Etienne M, Gueit I, Jouneau S, Delaval P, Mouthon L, Pouget J, Serratrice J, Brion JP, Vaylet F, Bremont C, Chennebault JM, Jaffuel S, Broussolle C, Lortholary O, Sève P. Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases. QJM 2013; 106:523-39. [PMID: 23515400 DOI: 10.1093/qjmed/hct052] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM To describe the main characteristics and the treatment of cryptococcosis in patients with sarcoidosis. DESIGN Multicenter study including all patients notified at the French National Reference Center for Invasive Mycoses and Antifungals. METHODS Retrospective chart review. Each case was compared with two controls without opportunistic infections. RESULTS Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients. CONCLUSIONS Cryptococcosis is a significant opportunistic infection during extra-thoracic sarcoidosis, which occurs in one-third of the cases in patients without any treatment; it is not associated to severe CD4 lymphocytopenia and has a good prognosis.
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Affiliation(s)
- C Bernard
- Department of Internal Medicine, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
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Wach J, Kodjikian L, Le Scanff J, Le Roux K, Varron L, Broussolle C, Sève P. Uvéite antérieure aiguë et spondylarthrite méconnue : utilité des critères de Berlin. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Langrand C, Bihan H, Raverot G, Varron L, Androdias G, Borson-Chazot F, Brue T, Cathebras P, Pinede L, Muller G, Broussolle C, Cotton F, Valeyre D, Seve P. Hypothalamo-pituitary sarcoidosis: a multicenter study of 24 patients. QJM 2012; 105:981-95. [PMID: 22753675 DOI: 10.1093/qjmed/hcs121] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To assess clinical features, treatment and outcome of Hypothalamo-pituitary (HP) sarcoidosis and to determine whether HP is associated with a particular clinical phenotype of sarcoidosis. DESIGN Multicentric retrospective study. METHODS Retrospective chart review. Each patient was matched with two controls. RESULTS Twenty-four patients were identified (10 women, 14 men). Their median age at the sarcoidosis diagnosis was 31.5 years (range: 8-69 years). HP involvement occurred in the course of a previously known sarcoidosis in 11 cases (46%), whereas it preceded the diagnosis in 13 patients (54%). All but two patients had anterior pituitary dysfunction, 12 patients presented with diabetes insipidus. The most common hormonal features were gonadotropin deficiency (n=21), TSH deficiency (n=15) and hyperprolactinemia (n=12). Magnetic Resonance Imaging (MRI) revealed infundibulum involvement (n=8), pituitary stalk thickness (n=12) and involvement of the pituitary gland (n=14). All but two patients received prednisone. After a mean follow-up of 4 years, only two patients recovered from hormonal deficiencies. MRI abnormalities improved or disappeared in 12 cases under corticosteroid. There was no correlation between the hormonal dysfunctions and the radiologic outcomes. Patients with HP sarcoidosis had significantly more frequent sinonasal localizations and neurosarcoidosis and required a systemic treatment more frequently than controls. CONCLUSION Although HP sarcoidosis is unusual, physicians should be aware that such specific localization could be the first manifestation of sarcoidosis. HP involvement is associated with general severity of sarcoidosis. MRI abnormalities can improve or disappear under corticosteroid treatment, but most endocrine defects are irreversible.
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Affiliation(s)
- C Langrand
- Department of Endocrinology, Fédération d’Endocrinologie, Groupement hospitalier Est, and University of Claude Bernard Lyon 1, 59 Boulevard Pinel 69677 Bron Cedex, France
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Bouaziz A, Le Scanff J, Chapelon-Abric C, Varron L, Khenifer S, Gleizal A, Bentz MH, Barthel A, Valeyre D, Seve P. Oral involvement in sarcoidosis: report of 12 cases. QJM 2012; 105:755-67. [PMID: 22422021 DOI: 10.1093/qjmed/hcs042] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To assess the clinical features, treatment and outcome of oral sarcoidosis and to determine whether oral involvement is associated with a particular clinical phenotype of sarcoidosis. DESIGN Multicentric retrospective study. METHODS Retrospective chart review. Each patient was matched with four controls. RESULTS Twelve patients (9 women, 3 men) were identified. Their median age at sarcoidosis diagnosis was 38 years. Oral involvement was the first clinical evidence of sarcoidosis in seven cases and was a relapse symptom in five cases. Clinical presentations were nodules (n = 7) or ulcers (n = 5) and were mostly solitary. The tongue was the commonest site affected (n = 4), followed by lips (n = 3), oral mucosa (n = 2), palate (n = 2) and gingiva (n = 1). Patients with oral sarcoidosis were significantly younger and had more frequent lacrimal or salivary glands and upper airway tract clinical involvement than the controls; increased angiotensin-converting enzyme was less frequent in oral sarcoidosis. Multiple treatments of oral sarcoidosis were used: no treatment (n = 3), surgery (n = 2), corticosteroids (n = 7), hydroxychloroquine (n = 3), methotrexate (n = 2), doxycycline (n = 1). Methotrexate was efficient in one patient, hydroxychloroquine showed benefit in only 1 out of 3 patients. Three patients presented oral relapses. After a mean follow-up of 6 years, 10 patients experienced a complete (n = 7) or partial (n = 3) remission of oral sarcoidosis; stability was observed in the remaining two cases. CONCLUSION Although oral manifestations of sarcoidosis are unusual, physicians should be aware that this specific localization is frequently the first manifestation of the disease. Treatment modalities range from observation in asymptomatic patients to immunosuppressants for severe involvement.
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Affiliation(s)
- A Bouaziz
- Department of Internal Medicine, Hôpital de la Croix-Rousse, 69317 Lyon Cedex 04, France
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Seve P, Kodjikian L, Bernard C, Varron L, Denis P, Bancel B, Isaac S, Broussolle C. Est-ce que la biopsie des glandes salivaires accessoires est utile pour le diagnostic d’uvéites sarcoïdosiques ? Étude monocentrique de 115 cas. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Le Roux K, Leal C, Kodjikian L, Denis P, Varron L, Broussolle C, Seve P. Sclérites, aspects cliniques, étiologiques et thérapeutiques : à propos de 32 observations. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Varron L, Schott AM, Cottin V, Ninet J, Broussolle C, Seve P. Sarcoidose du sujet âgé : étude cas–témoins. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Varron L, Besson A, Raharisondraibe E, Ait S, Bonnefoy M. Hemichorea in an elderly patient revealing primary antiphospholipid syndrome. Eur Geriatr Med 2010. [DOI: 10.1016/j.eurger.2010.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Varron L, Broussolle C, Candessanche JP, Marignier R, Rousset H, Ninet J, Sève P. Spinal cord sarcoidosis: report of seven cases. Eur J Neurol 2009; 16:289-96. [DOI: 10.1111/j.1468-1331.2008.02409.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mainta I, Varron L, Rousset H, Vital Durand D. Anévrisme pulmonaire périphérique idiopathique : chirurgie ou surveillance ? Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Varron L, Kodjikian L, Billotey C, Grange JD, Gomard EM, Broussolle C, Seve P. Apport de la tomographie par émission de positons au 18-Fluorodéoxyglucose pour le diagnostic d'uvéite sarcoïdosique chez les patients avec tomodensitométrie thoracique normale. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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