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Hutt E, Jaber WA, Jellis C, Mountis MM, Cremer PC. Novel dietary protocol prior to 18F-fluorodeoxyglucose positron emission tomography to evaluate for cardiac sarcoidosis. J Nucl Cardiol 2021; 28:2190-2193. [PMID: 33051803 DOI: 10.1007/s12350-020-02392-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
The diagnosis of cardiac sarcoidosis (CS) is challenging. Recently, guidelines incorporated cardiac positron emission tomography (PET) with 18F-Fluorodeoxyglucose (F18-FDG) as a non-invasive diagnostic modality for the detection and follow-up of CS. However, this technique is dependent of patient dietary preparation to suppress physiological myocardial F18-FDG uptake. We present a case of possible CS which highlights a novel preparation protocol that facilitated appropriate myocardial suppression.
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Affiliation(s)
- Erika Hutt
- Cardiovascular Medicine Department, Cleveland Clinic Foundation, 9500 Euclid Ave, NA3-129, Cleveland, OH, USA.
| | - Wael A Jaber
- Cardiovascular Medicine Department, Cleveland Clinic Foundation, 9500 Euclid Ave, NA3-129, Cleveland, OH, USA
| | - Christine Jellis
- Cardiovascular Medicine Department, Cleveland Clinic Foundation, 9500 Euclid Ave, NA3-129, Cleveland, OH, USA
| | - Maria M Mountis
- Cardiovascular Medicine Department, Cleveland Clinic Foundation, 9500 Euclid Ave, NA3-129, Cleveland, OH, USA
| | - Paul C Cremer
- Cardiovascular Medicine Department, Cleveland Clinic Foundation, 9500 Euclid Ave, NA3-129, Cleveland, OH, USA
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2
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Affiliation(s)
- Marjolein Drent
- From the Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht, and the ILD Care Foundation Research Team, Ede - all in the Netherlands (M.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (E.D.C.); and the Respiratory Medicine Division, Department of Medicine Solna, and the Center for Molecular Medicine, Karolinska Institutet, and Respiratory Medicine, Theme Inflammation and Aging, Karolinska University Hospital - both in Stockholm (J.G.)
| | - Elliott D Crouser
- From the Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht, and the ILD Care Foundation Research Team, Ede - all in the Netherlands (M.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (E.D.C.); and the Respiratory Medicine Division, Department of Medicine Solna, and the Center for Molecular Medicine, Karolinska Institutet, and Respiratory Medicine, Theme Inflammation and Aging, Karolinska University Hospital - both in Stockholm (J.G.)
| | - Johan Grunewald
- From the Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht, and the ILD Care Foundation Research Team, Ede - all in the Netherlands (M.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (E.D.C.); and the Respiratory Medicine Division, Department of Medicine Solna, and the Center for Molecular Medicine, Karolinska Institutet, and Respiratory Medicine, Theme Inflammation and Aging, Karolinska University Hospital - both in Stockholm (J.G.)
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Koyanagawa K, Naya M, Aikawa T, Manabe O, Furuya S, Kuzume M, Oyama-Manabe N, Ohira H, Tsujino I, Anzai T. The rate of myocardial perfusion recovery after steroid therapy and its implication for cardiac events in cardiac sarcoidosis and primarily preserved left ventricular ejection fraction. J Nucl Cardiol 2021; 28:1745-1756. [PMID: 31605274 DOI: 10.1007/s12350-019-01916-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/01/2019] [Accepted: 09/23/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Sarcoidosis is a multisystemic disorder of unknown cause characterized by immune granuloma formation in the involved organs. Few studies have reported on the myocardial perfusion changes by immunosuppression therapy in cardiac sarcoidosis (CS). Additionally, the relationship between myocardial perfusion changes and prognosis is unknown. Therefore, this study aimed to clarify myocardial perfusion recovery after steroid therapy and its prognostic value for major adverse cardiac events (MACE) in patients with CS. METHODS AND RESULTS Thirty-eight consecutive patients with CS {median age, 63 [interquartile range (IQR) 51-68] years; 10 men} underwent both 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and electrocardiography-gated single-photon emission CT (SPECT) pre- and post-steroid therapy. Patients with improved or preserved myocardial perfusion after post-therapy were defined as the recovery group and those with worsened myocardial perfusion as the non-recovery group. Twenty-six patients (68%) were categorized as the recovery group. MACE occurred in eight patients. The Kaplan-Meier curves revealed a significantly higher rate of MACE in the non-recovery group (17.4%/y vs 2.9%/y, P = 0.007). CONCLUSIONS Myocardial perfusion was recovered by steroid therapy in 61% and preserved in 8% of patients. Myocardial perfusion recovery after steroid therapy was significantly associated with a low incidence of MACE.
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Affiliation(s)
- Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Osamu Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Sho Furuya
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Masato Kuzume
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
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Schmidt TJ, Rosenbaum AN, Kolluri N, Stulak JM, Daly RC, Schirger JA, Elwazir MY, Kapa S, Cooper LT, Blauwet LA. Natural History of Patients Diagnosed with Cardiac Sarcoidosis at Left Ventricular Assist Device Implantation or Cardiac Transplantation. ASAIO J 2021; 67:583-587. [PMID: 33902104 DOI: 10.1097/mat.0000000000001262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To our knowledge, natural history has not been reported for cardiac sarcoidosis (CS) diagnosed by pathologic evaluation of the apical core at left ventricular assist device (LVAD) implantation or cardiac transplantation. We retrospectively identified 232 consecutive patients meeting CS criteria. Of these patients, 54 were diagnosed by pathologic confirmation of CS, 10 after evaluation of the apical core (LVAD implant) or explanted heart (transplant). We compared clinical characteristics at initial evaluation and outcomes for these 10 patients with those of 10 patients with known CS before LVAD implant/transplant. In the study group, five patients (50%) had confirmed extracardiac sarcoidosis before LVAD implant/transplant; five had not been diagnosed with sarcoidosis. Mean (standard deviation) left ventricular ejection fraction at initial evaluation was 23% (16%), and left ventricular end-diastolic dimension was 61 (10) mm. Four patients died during follow-up; however, no survival difference was found for the 10 patients diagnosed incidentally and the group with a previous diagnosis or institutional LVAD/transplant cohorts. Patients diagnosed with CS on pathological examination of the apical core/explanted heart may have severe dilated cardiomyopathy as the initial presentation. Outcomes for patients with CS after advanced heart failure therapies may be comparable with those of non-CS patients.
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Affiliation(s)
| | | | | | - John M Stulak
- Department of Cardiovascular Surgery
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
| | - John A Schirger
- Department of Cardiovascular Medicine
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
| | | | | | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
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5
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Garrì F, Rinaldi F, Perini P, Miscioscia A, Simonato D, Pizzi M, Margoni M, Gallo P. Slowly Progressive Optic Perineuritis as the First Clinical Manifestation of Sarcoidosis. J Neuroophthalmol 2021; 41:e39-e41. [PMID: 32141980 DOI: 10.1097/wno.0000000000000924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Federica Garrì
- Neurology Unit (FG, FR, PP, AM, MM, PG), University Hospital of Padova, Padova, Italy ; Neuroradiology Unit (DS), University Hospital of Padova, Padova, Italy ; and General Pathology and Cytopathology Unit (MP), Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
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6
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Koyanagawa K, Naya M, Aikawa T, Manabe O, Kuzume M, Ohira H, Tsujino I, Tamaki N, Anzai T. Prognostic value of phase analysis on gated single photon emission computed tomography in patients with cardiac sarcoidosis. J Nucl Cardiol 2021; 28:128-136. [PMID: 30815835 DOI: 10.1007/s12350-019-01660-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to determine the correlation between phase analysis, reflecting the heterogeneity of perfusion defects, and the dyssynchrony of the left ventricle wall motion, and adverse cardiac events in cardiac sarcoidosis (CS) patients. METHODS Fifty-seven consecutive patients with diagnosed CS (64 [IQR 55-71] years old, 14 males), who underwent 18F-FDG PET/CT and ECG-gated SPECT, were studied. FDG PET was analysed to measure cardiac metabolic volume (CMV), and total lesion glycolysis (TLG). The SPECT findings, such as LVEF, Summed Rest Score (SRS), bandwidth (BW) were evaluated. RESULTS The median of BW was 56° (IQR 40-95). BW showed a strong inverse correlation with LVEF (r = - 0.60, P < 0.0001), and positive correlation with SRS (r = 0.82, P < 0.0001). However, there were no significant correlations between BW and CMV or TLG. The Kaplan-Meier curves revealed a significantly higher rate of MACE in the high BW group (BW > 56°) than the low BW group (BW ≤ 56°) (15.1%/years vs. 4.4%/years, P = 0.025). In multivariable analysis, BW was a significant independent predictor of MACE (P = 0.015). CONCLUSION Phase analysis on gated SPECT was a significant and independent predictor of MACE in patients with CS.
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Affiliation(s)
- Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masato Kuzume
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
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Arai T, Kasai T, Shimizu K, Kawahara K, Katayama K, Sugimoto C, Hirose M, Okamoto H, Tachibana K, Akira M, Inoue Y. Autoimmune Pulmonary Alveolar Proteinosis Complicated with Sarcoidosis: the Clinical Course and Serum Levels of Anti-granulocyte-macrophage colony-stimulating Factor Autoantibody. Intern Med 2020; 59:2539-2546. [PMID: 32611952 PMCID: PMC7662056 DOI: 10.2169/internalmedicine.3853-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Autoimmune pulmonary alveolar proteinosis (APAP) is caused by macrophage dysfunction due to anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibody. We experienced 2 cases of APAP complicated with sarcoidosis in a 42-year-old woman and a 51-year-old man (age at the sarcoidosis diagnosis). APAP preceded sarcoidosis in the woman, and both diseases were diagnosed simultaneously in the man. Sarcoidosis lesions were observed in the lung, skin, and eyes, and the pathological findings of APAP were not marked at the diagnosis of sarcoidosis in either case. Low-grade positive serum anti-GM-CSF autoantibody was suspected to be correlated with the occurrence of sarcoidosis and resolution of APAP.
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Affiliation(s)
- Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Kazunori Shimizu
- Department of Pulmonary Critical Care Medicine, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Japan
| | - Kanako Katayama
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Chikatoshi Sugimoto
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Masaki Hirose
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | | | - Kazunobu Tachibana
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Masanori Akira
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
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Noda S, Maeda A, Komiya Y, Soejima M. A Patient with Necrotizing Vasculitis Related to Sarcoidosis, which Was Diagnosed via Immunohistochemical Methods Using Propionibacterium acnes-specific Monoclonal Antibodies. Intern Med 2020; 59:2423-2425. [PMID: 32536653 PMCID: PMC7644481 DOI: 10.2169/internalmedicine.4918-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Propionibacterium acnes (P. acnes) is a commensal bacterium indigenous to the skin. Previous reports have suggested that infection with P. acnes causes sarcoidosis, a systemic granulomatous disease. We present the case of a 63-year-old woman who developed subcutaneous nodules. A skin biopsy revealed necrotizing vasculitis and noncaseating granulomas, which are characteristic of sarcoidosis. Immunohistostaining revealed a P. acnes skin infection, which led to the diagnosis of sarcoidosis. Minocycline treatment resolved the infection and improved the patient's symptoms. We herein report a case in which immunohistochemistry was useful in the diagnosis of sarcoidosis.
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Affiliation(s)
- Seiji Noda
- Department of Rheumatology, Ome General Municipal Hospital, Japan
| | - Ayaka Maeda
- Department of Rheumatology, Ome General Municipal Hospital, Japan
| | - Yoji Komiya
- Department of Rheumatology, Ome General Municipal Hospital, Japan
| | - Makoto Soejima
- Department of Rheumatology, Ome General Municipal Hospital, Japan
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9
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Korkmaz C, Demircioglu S. The Association of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios and Hematological Parameters with Diagnosis, Stages, Extrapulmonary Involvement, Pulmonary Hypertension, Response to Treatment, and Prognosis in Patients with Sarcoidosis. Can Respir J 2020; 2020:1696450. [PMID: 33062080 PMCID: PMC7555456 DOI: 10.1155/2020/1696450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/16/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is a rare disease characterized by granulomatous inflammation in affected organs, primarily in lungs. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are easy and practical methods providing valuable information in diagnosis, severity, and prognosis of various diseases. Here, we aimed to investigate the association between NLR, PLR, and hematological parameters in sarcoidosis. The study was performed with 75 sarcoidosis patients and 92 controls. Patients' NLR, PLR, and hematological parameters were compared with those of controls. Additionally, while differences between NLR and PLR were investigated in sarcoidosis patients, differences of extrapulmonary involvement, pulmonary hypertension (PH), and spontaneous remission between those with and without responses to treatment concerning stages were also assessed. NLR and PLR were significantly higher in sarcoidosis patients than controls. For NLR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found as 68, 61, 58, and 70% respectively, while sensitivity, specificity, PPV, and NPV for PLR were found as 72, 67, 63, and 74%, respectively. In sarcoidosis patients, NLR and PLR were significantly higher at stage-2 and -3 than at stage -1 and -4. There was a significant weak positive correlation between C-reactive protein (CRP) and NLR and PLR. Mean platelet volume (MPV), hemoglobin (Hgb), and mean corpuscular volume (MCV) were lower among patients than controls. A positive moderate correlation was detected between NLR and CD4/CD8 in blood, while there was a strong positive correlation between CD4/CD8 in bronchoalveolar lavage (BAL) and positive moderate correlation between PLR and CD4/CD8 in BAL. High NLR and PLR values were not significantly associated with pulmonary PH, spontaneous remission, response to treatment, and prognosis. The increase in PLR and NLR may be a guide for diagnoses of both sarcoidosis and lung parenchymal involvement. To use these entities as markers, our findings should be supported with prospective studies with larger samples.
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Affiliation(s)
- Celalettin Korkmaz
- Department of Chest Diseases, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sinan Demircioglu
- Department of Internal Medicine, Division of Hematology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 425] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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11
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Al-Mayouf SM, Almutairi A, Albrawi S, Fathalla BM, Alzyoud R, AlEnazi A, Abu-Shukair M, Alwahadneh A, Alsonbul A, Zlenti M, Khawaja E, Abushhaiwia A, Khawaja K, AlMosawi Z, Madan W, Almuatiri M, Almuatiri N. Pattern and diagnostic evaluation of systemic autoinflammatory diseases other than familial Mediterranean fever among Arab children: a multicenter study from the Pediatric Rheumatology Arab Group (PRAG). Rheumatol Int 2019; 40:49-56. [PMID: 31741047 DOI: 10.1007/s00296-019-04478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/08/2019] [Indexed: 01/30/2023]
Abstract
To define the spectrum and phenotypic characteristics of systemic autoinflammatory diseases (SAIDs) other than familial Mediterranean fever (FMF) in Arab children and to delineate diagnostic evaluation. Data retrospectively collected on patients with clinical and/or genetically proven SAIDs other than FMF at 10 tertiary Arab pediatric rheumatology clinics from 1990 to 2018. The collected data comprised the clinical findings and diagnostic evaluation including genetic testing, the provided treatment and the accrual damage related to SAIDs. A total of 144 patients (93 female) with a median age at onset of 2.5 (range 0.1-12) years were enrolled. The initial diagnosis was inaccurate in 49.3%. Consanguinity rate among parents was 74.6%. The median time-to-diagnosis for all SAIDs was 2.5 (range 0.1-10) years. There were 104 patients (72.2%) with a confirmed diagnosis and 40 patients with suspected SAIDs. Seventy-two had monogenic and 66 patients with multifactorial SAIDs while six patients had undifferentiated SAIDs. The most frequent monogenic SAIDs were LACC1 mediated monogenic disorders (n = 23) followed by CAPS (12), TRAPS (12), HIDS (12), and Majeed's syndrome (6). The most frequent multifactorial SAIDs was CRMO (34), followed by PFAPA (18), and early onset sarcoidosis (EOS) (14). Genetic analysis was performed in 69 patients; 50 patients had genetically confirmed disease. Corticosteroid used for 93 patients while biologic agents for 96 patients. Overall, growth failure was the most frequent accrual damage (36%), followed by cognitive impairment (13%). There were three deaths because of infection. This study shows a heterogenous spectrum of SAIDs with a high number of genetically confirmed monogenic diseases; notably, LACC1 associated diseases. Hopefully, this work will be the first step for a prospective registry for SAIDs in Arab countries.
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MESH Headings
- Acne Vulgaris/diagnosis
- Acne Vulgaris/drug therapy
- Acne Vulgaris/epidemiology
- Acne Vulgaris/physiopathology
- Adolescent
- Anemia, Dyserythropoietic, Congenital/diagnosis
- Anemia, Dyserythropoietic, Congenital/drug therapy
- Anemia, Dyserythropoietic, Congenital/epidemiology
- Anemia, Dyserythropoietic, Congenital/physiopathology
- Antirheumatic Agents/therapeutic use
- Arabs
- Arthritis/diagnosis
- Arthritis/drug therapy
- Arthritis/epidemiology
- Arthritis/physiopathology
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/drug therapy
- Arthritis, Infectious/epidemiology
- Arthritis, Infectious/physiopathology
- Arthritis, Juvenile/drug therapy
- Arthritis, Juvenile/epidemiology
- Arthritis, Juvenile/genetics
- Arthritis, Juvenile/physiopathology
- Bahrain/epidemiology
- Child
- Child, Preschool
- Consanguinity
- Crohn Disease/drug therapy
- Crohn Disease/epidemiology
- Crohn Disease/genetics
- Crohn Disease/physiopathology
- Cross-Sectional Studies
- Cryopyrin-Associated Periodic Syndromes/diagnosis
- Cryopyrin-Associated Periodic Syndromes/drug therapy
- Cryopyrin-Associated Periodic Syndromes/epidemiology
- Cryopyrin-Associated Periodic Syndromes/physiopathology
- Diagnostic Errors
- Female
- Fever/diagnosis
- Fever/drug therapy
- Fever/epidemiology
- Fever/physiopathology
- Hereditary Autoinflammatory Diseases/diagnosis
- Hereditary Autoinflammatory Diseases/drug therapy
- Hereditary Autoinflammatory Diseases/epidemiology
- Hereditary Autoinflammatory Diseases/physiopathology
- Humans
- Immunologic Deficiency Syndromes/diagnosis
- Immunologic Deficiency Syndromes/drug therapy
- Immunologic Deficiency Syndromes/epidemiology
- Immunologic Deficiency Syndromes/physiopathology
- Infant
- Intracellular Signaling Peptides and Proteins/genetics
- Jordan/epidemiology
- Kuwait/epidemiology
- Libya/epidemiology
- Male
- Mevalonate Kinase Deficiency/diagnosis
- Mevalonate Kinase Deficiency/drug therapy
- Mevalonate Kinase Deficiency/epidemiology
- Mevalonate Kinase Deficiency/physiopathology
- Oman/epidemiology
- Osteomyelitis/diagnosis
- Osteomyelitis/drug therapy
- Osteomyelitis/epidemiology
- Osteomyelitis/physiopathology
- Pyoderma Gangrenosum/diagnosis
- Pyoderma Gangrenosum/drug therapy
- Pyoderma Gangrenosum/epidemiology
- Pyoderma Gangrenosum/physiopathology
- Retrospective Studies
- Sarcoidosis/diagnosis
- Sarcoidosis/drug therapy
- Sarcoidosis/epidemiology
- Sarcoidosis/physiopathology
- Saudi Arabia/epidemiology
- Synovitis/diagnosis
- Synovitis/drug therapy
- Synovitis/epidemiology
- Synovitis/physiopathology
- United Arab Emirates/epidemiology
- Uveitis/diagnosis
- Uveitis/drug therapy
- Uveitis/epidemiology
- Uveitis/physiopathology
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Affiliation(s)
- Sulaiman M Al-Mayouf
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Alfaisal University, Po Box 3354, Riyadh, 11211, Saudi Arabia.
| | - Abdulaziz Almutairi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Alfaisal University, Po Box 3354, Riyadh, 11211, Saudi Arabia
| | | | - Basil M Fathalla
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | | | | | | | | | - Abdullah Alsonbul
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Alfaisal University, Po Box 3354, Riyadh, 11211, Saudi Arabia
| | | | | | | | | | | | - Wafa Madan
- Salmaniya Medical Complex, Manama, Bahrain
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12
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Martusewicz-Boros MM, Boros PW, Wiatr E, Zych J, Kempisty A, Kram M, Piotrowska-Kownacka D, Wesołowski S, Baughman RP, Roszkowski-Sliż K. Cardiac sarcoidosis: worse pulmonary function due to left ventricular ejection fraction?: A case-control study. Medicine (Baltimore) 2019; 98:e18037. [PMID: 31764823 PMCID: PMC6882660 DOI: 10.1097/md.0000000000018037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dyspnea and exercise intolerance are usually attributed to pulmonary disease in sarcoidosis patients. However, cardiac involvement may also be responsible for these symptoms. Data regarding the impact of heart involvement on lung function in cardiac sarcoidosis (CS) is limited.The aim of study was to compare the results of pulmonary function tests (PFTs) in patients with and without heart involvement. We performed a retrospective analysis of PFTs in a group of sarcoidosis patients both with and without heart involvement evaluated by cardiovascular magnetic resonance (CMR) study. The study was performed in the period between May 2008 and April 2016.We included data of sarcoidosis patients who underwent testing for possible CS (including CMR study) at a national tertiary referral center for patients with interstitial lung diseases. All patients had histopathologicaly confirmed sarcoidosis and underwent standard evaluation with PFTs measurements including spirometry, plethysmography, lung transfer factor (TL,CO), and 6-minute walking test (6MWT) assessed using the most recent predicted values.We identified 255 sarcoidosis patients (93 women, age 42 ± 10.7 y): 103 with CS and 152 without CS (controls). CS patients had significantly lower left ventricular ejection fraction (LVEF; 56.9 ± 7.0 vs 60.4 ± 5.4, P < .001). Any type of lung dysfunction was seen in 63% of CS patients compared with 31% in the controls (P = .005). Ventilatory disturbances (obstructive or restrictive pattern) and low TL,CO were more frequent in CS group (52% vs 23%, P < .001 and 38% vs 18% P < .01 respectively). CS (OR = 2.13, 95% CI: 1.11-4.07, P = .02), stage of the disease (OR = 3.13, 95% CI: 1.4-7.0, P = .006) and LVEF (coefficient = -0.068 ± 0.027, P = .011) were independent factors associated with low FEV1 but not low TL,CO. There was a significant correlation between LVEF and FEV1 in CS group (r = 0.31, n = 89, P = .003). No significant difference in 6MWD between CS patients and controls was observed.Lung function impairment was more frequent in CS. Lower LVEF was associated with decreased values of FEV1. Relatively poor lung function may be an indication of cardiac sarcoidosis.
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Affiliation(s)
| | | | | | | | | | - Marek Kram
- Rehabilitation Department, National TB & Lung Diseases Research Institute, Warsaw
| | | | | | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
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13
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Rivière E, Schwartz P, Machelart I, Greib C, Pellegrin JL, Viallard JF, Lazaro E. Neurosarcoidosis and infliximab therapy monitored by 18FDG PET/CT. QJM 2019; 112:695-697. [PMID: 31225618 DOI: 10.1093/qjmed/hcz148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/03/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- E Rivière
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, France
- INSERM U1034, University of Bordeaux, Pessac, France
| | - P Schwartz
- Nuclear Medicine Department, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, France
| | - I Machelart
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, France
| | - C Greib
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, France
| | - J-L Pellegrin
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, France
- CIRID, UMR/CNRS 5164, University of Bordeaux, Bordeaux, France
| | - J-F Viallard
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, France
- INSERM U1034, University of Bordeaux, Pessac, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, France
- CIRID, UMR/CNRS 5164, University of Bordeaux, Bordeaux, France
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14
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Esposito V, Catucci D, Colucci M, Torreggiani M, Grosjean F, Esposito C. Consecutive episodes of heart and kidney failure in an "otherwise" healthy young man. BMC Nephrol 2019; 20:229. [PMID: 31221126 PMCID: PMC6587250 DOI: 10.1186/s12882-019-1414-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 06/06/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute renal failure is a rare occurrence in a patient with an unremarkable past medical history and should always lead to an in depth clinical study. The occurrence in the same healthy young subject, of consecutive episodes of heart failure and of acute renal failure is an even rarer event and should prompt diagnostic tests and restrict the diagnostic hypotheses. CASE PRESENTATION We present the case of a 28 year-old man who, while waiting to undergo assessment for a mild chronic kidney disease, was diagnosed with decompensated dilated cardiomyopathy and placed on diuretics and β-blockers. After few weeks he developed a non oligoanuric acute renal failure with a slight elevation of serum calcium. Renal biopsy proved suggestive for renal sarcoidosis; thus the hypothesis of systemic sarcoidosis with cardiac and renal involvement was possible avoiding further delay in initiation of therapy. CONCLUSIONS Cardiac sarcoidosis is usually silent but the majority of cases are diagnosed when cardiac symptoms are present in a patient with systemic sarcoidosis. Renal involvement with granulomatous interstitial nephritis is also quite rare and can be an unexpected finding at kidney biopsy. This case highlights the need to evaluate thoroughly clinical problems that do not fit in a specific scenario and emphasizes the importance of performing a kidney biopsy in case of kidney failure of unknown etiology.
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Affiliation(s)
- V. Esposito
- Unit of Nephrology, ICS S. Maugeri SpA SB, Pavia, Italy
| | - D. Catucci
- Unit of Nephrology, ICS S. Maugeri SpA SB, Pavia, Italy
| | - M. Colucci
- Unit of Nephrology, ICS S. Maugeri SpA SB, Pavia, Italy
- University of Pavia, Via S. Maugeri 10, 27100 Pavia, Italy
| | | | - F. Grosjean
- Unit of Nephrology, IRCCS Policlinico San Matteo, Via Camillo Golgi 19, 27100 Pavia, Italy
| | - C. Esposito
- Unit of Nephrology, ICS S. Maugeri SpA SB, Pavia, Italy
- University of Pavia, Via S. Maugeri 10, 27100 Pavia, Italy
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15
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Gunathilaka PK, Mukherjee A, Jat KR, Lodha R, Kabra SK. Clinical Profile and Outcome of Pediatric Sarcoidosis. Indian Pediatr 2019; 56:37-40. [PMID: 30806359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To document clinical features and outcome of children with sarcoidosis. METHODS Case records of 18 children (mean (SD) age 9 (2.2) years) diagnosed with sarcoidosis between 2006 and 2016 were reviewed. All children were followed up every 2-3 months and monitored for clinical and laboratory parameters. Their treatment and outcome were recorded. RESULTS Clinical features at the time of diagnosis were fever (83%), uveitis (50%), difficulty in breathing (44%), hepatosplenomegaly, weight loss, arthritis and peripheral adenopathy. Imaging findings included: hilar adenopathy (94%), abdominal nodes (50%) and pulmonary infiltrates (44%). All children were treated with steroids (range 6-12 months) and weekly low dose oral methotrexate. All patients showed significant improvement over a mean (SD) duration of follow-up of 3.1 (0.9) years, as assessed by resolution of clinical symptoms, and improvement in spirometry parameters, erythrocyte sedimentation rate, and serum angiotensin converting enzyme levels. CONCLUSIONS Children with sarcoidosis seem to respond well to systemic steroids and low dose methotrexate. Delayed diagnosis and ocular involvement are probably associated with poor outcome.
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Affiliation(s)
- P Kg Gunathilaka
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Prof SK Kabra, Department of Pediatrics, All India Institute of Medical Sciences,New Delhi 110 029, India.
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16
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Schupp JC, Fichtner UA, Frye BC, Heyduck-Weides K, Birring SS, Windisch W, Criée CP, Müller-Quernheim J, Farin E. Psychometric properties of the German version of the Leicester Cough Questionnaire in sarcoidosis. PLoS One 2018; 13:e0205308. [PMID: 30286204 PMCID: PMC6171952 DOI: 10.1371/journal.pone.0205308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background Cough is one of the most common symptoms in general and pulmonary medicine with profound negative impact on health-related quality of life (HRQL). The Leicester Cough Questionnaire (LCQ) is a validated HRQL questionnaire, yet a validated German version of the LCQ is not available and it has never been tested in a cohort with sarcoidosis. Objectives To translate the LCQ into German and determine its psychometric properties. Methods The LCQ was translated in a forward-backward approach. Structured interviews in sarcoidosis patients were performed. Subsequently, sarcoidosis patients were asked to answer the German LCQ and comparative questionnaires. Distribution properties, item difficulty, concurrent validity, Rasch model fit and internal consistency of the German LCQ were determined. Results 200 patients with sarcoidosis were included. We provide evidence for reliability, unidimensionality and internal consistency. However, only a moderate correlation with general and respiratory-specific HRQL questionnaires, no Rasch model fit could be shown. Skewed responses caused by floor effects were detected. Conclusion We demonstrate that the German LCQ is valid and reliable and its psychometric properties fulfil the standards required for its use in clinical settings as well as in interventional trials.
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Affiliation(s)
- Jonas Christian Schupp
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Urs Alexander Fichtner
- Institute for Quality Management and Social Medicine, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Björn Christian Frye
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Katja Heyduck-Weides
- Institute for Quality Management and Social Medicine, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Surinder S. Birring
- Division of Asthma, Allergy and Lung Biology, King’s College London, London, United Kingdom
| | - Wolfram Windisch
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Carl-Peter Criée
- Department of Sleep and Respiratory Medicine, Evangelical Hospital Göttingen-Weende, Bovenden, Germany
| | | | - Erik Farin
- Institute for Quality Management and Social Medicine, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- * E-mail:
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17
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Takayama K, Harimoto K, Sato T, Sakurai Y, Taguchi M, Kanda T, Takeuchi M. Age-related differences in the clinical features of ocular sarcoidosis. PLoS One 2018; 13:e0202585. [PMID: 30138345 PMCID: PMC6107189 DOI: 10.1371/journal.pone.0202585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/06/2018] [Indexed: 12/05/2022] Open
Abstract
The distribution of age at diagnosis in ocular sarcoidosis has shifted towards the older age groups in developed countries. In systemic sarcoidosis, age-related differences in the clinical presentation, which reflect the therapeutic strategies, was reported. We retrospectively compared 100 consecutive patients from April 2010 to March 2016 who were initially diagnosed with ocular sarcoidosis by International Workshop on Ocular Sarcoidosis criteria. They were classified into elder (>65 years: 50 patients) and younger (≤65 years: 50 patients) groups by the age at diagnosis of uveitis associated with sarcoidosis. All patients received ophthalmic examination to assess the presence of seven intraocular signs and 4 laboratory parameters. Significantly fewer ocular signs (2.8 ± 1.5 and 3.6 ± 1.5; P = 0.0034) and abnormal laboratory results (1.5 ± 1.2 and 2.0 ± 1.2; P = 0.023) were detected in the elder group than in the younger group; statistical differences were found between the groups regarding the frequencies of mutton-fat keratic precipitates (40% and 64%; P = 0.012), vitreous opacities (60% and 78%; P = 0.0059), bilateral inflammation (64% and 80%; P = 0.012), and bilateral hilar lymphadenopathy between the groups (52% and 78%; P < 0.001). Multiple linear regression analysis showed negative correlations between age and number of detected ocular signs (r = −0.36, P < 0.001) and laboratory results (r = −0.20, P = 0.023). The characteristic ocular signs and abnormal laboratory results had a lower frequency in the elder patients compared with the younger patients. Probable or possible ocular sarcoidosis by the international criteria should increase with increased life expectancy in developed countries.
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Affiliation(s)
- Kei Takayama
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Kozo Harimoto
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Yutaka Sakurai
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Manzo Taguchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
- * E-mail:
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18
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Møller J, Hellmund V, Hilberg O, Løkke A. [Sarcoidosis]. Ugeskr Laeger 2018; 180:V10170777. [PMID: 30152318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown cause, histologically characterised by non-caseating granulomas. Sarcoidosis most commonly affects the lungs, but all organs can be involved, and there is a variable natural course from an asymptomatic state to a progressive disease. Sarcoidosis is a diagnosis of exclusion, and CT scan, endobronchial ultrasound-guided trans-bronchial needle aspiration and fluorodeoxyglucose positron emission tomography facilitate the diagnostic workup. Patients with severe symptoms or threatening organ damage require systemic treatment.
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19
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Öztürk A, Kayacan O. Rising stars of DPLD survival: FVC and exercise desaturation (a single-center study). Turk J Med Sci 2018; 48:826-832. [PMID: 30119159 DOI: 10.3906/sag-1802-196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim Diffuse parenchymal lung diseases (DPLDs) comprise a broad, heterogeneous group of diseases with common
functional characteristics and a common final pathway, usually leading to irreversible fibrosis. We investigated the effects of the
physiological and functional parameters and of pulmonary hypertension (PH) on survival in DPLDs. Materials and methods The study included 158 patients with DPLDs. Patient data were examined retrospectively, and survival status
was obtained through phone calls. Results Patients were divided into five groups according to their diagnosis: idiopathic pulmonary fibrosis (IPF), non-IPF idiopathic
interstitial pneumonias, connective tissue diseases, sarcoidosis, and other DPLDs. Median survival was 42.9 months. The significant
negative effects of older age, presence of delta saturation (DeltaSat; difference between oxygen saturation at rest and after the 6-min
walking test), 6-min walking distance (<350 m), systolic pulmonary artery pressure (sPAP; ≥50 mmHg), and baseline percentage of
diffusing capacity of the lungs for carbon monoxide (<80%) with percentage of forced vital capacity (FVC%; <80%) were detected on
survival (P < 0.05). A one-unit decrease in FVC% was related to a 6% increase in mortality. Another unique finding indicated that higher
DeltaSat (>10%) correlated strongly with sPAP (>50 mmHg) and thus with a worse survival rate. Conclusion The current study determined that FVC% is important in the prediction of mortality. Moreover, it demonstrated a strong
relationship between exercise desaturation and PH.
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20
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Wang F, Guo D, Liu Z, Zhou A, Wei C, Jia J. Neurosarcoidosis: clinical characteristics, diagnosis, and treatment in eight Chinese patients. Neurol Sci 2018; 39:1725-1733. [PMID: 30088165 DOI: 10.1007/s10072-018-3491-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Abstract
Neurosarcoidosis is relatively rare and has diverse manifestations. The clinical characteristics, diagnosis, treatment, and outcome for neurosarcoidosis in China are poorly understood. We retrospectively analyzed the clinical features, laboratory and imaging results, treatment, and outcomes in patients who met the criteria for definite or probable neurosarcoidosis in Xuan Wu Hospital of Capital Medical University from 2000 to 2015. Eight patients were included in this study, accounting for 5.84% of all cases with sarcoidosis. The mean age at onset was 50.25 years, and 75% of the patients were female. Five cases had a prior diagnosis of extraneurologic sarcoidosis, leading to a shorter lag time between onset of symptoms and diagnosis (3.4 vs. 16.2 months). Neurological symptoms were the first clinical feature of sarcoidosis in three cases, and no patients presented isolated nervous system manifestation. The most common symptom was sensory disturbance, and the most common site of nervous system involvement was brain parenchyma and meninges. Disturbance of consciousness, seizures, hydrocephalus, and abnormal CSF assays were associated with poor prognosis. All patients were treated with corticosteroids and one was also given azathioprine. Five patients had complete or partial improvement, one remained stabilized, and two deteriorated and died. Neurosarcoidosis is difficult to diagnose early and might be associated with a poor prognosis. Tissue biopsy for a definitive diagnosis and aggressive therapy with corticosteroids plus other alternative immunosuppressive treatment should be recommended in China.
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Affiliation(s)
- Fen Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Changchun Street 45, Xicheng District, Beijing, 100053, People's Republic of China
| | - Dongmei Guo
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Changchun Street 45, Xicheng District, Beijing, 100053, People's Republic of China
| | - Zheng Liu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Changchun Street 45, Xicheng District, Beijing, 100053, People's Republic of China
| | - Aihong Zhou
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Changchun Street 45, Xicheng District, Beijing, 100053, People's Republic of China
| | - Cuibai Wei
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Changchun Street 45, Xicheng District, Beijing, 100053, People's Republic of China
| | - Jianping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Changchun Street 45, Xicheng District, Beijing, 100053, People's Republic of China.
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21
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Okada DR, Bravo PE, Vita T, Agarwal V, Osborne MT, Taqueti VR, Skali H, Chareonthaitawee P, Dorbala S, Stewart G, Di Carli M, Blankstein R. Isolated cardiac sarcoidosis: A focused review of an under-recognized entity. J Nucl Cardiol 2018; 25:1136-1146. [PMID: 27613395 PMCID: PMC5540795 DOI: 10.1007/s12350-016-0658-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 02/07/2023]
Abstract
There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.
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Affiliation(s)
- David R Okada
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Tomas Vita
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vikram Agarwal
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael T Osborne
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Viviany R Taqueti
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | | | - Sharmila Dorbala
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Garrick Stewart
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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22
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Affiliation(s)
- Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Miami, FL, USA.
| | - Hesham R Omar
- Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA
| | - Nadera Sweiss
- Division of Pulmonary, Critical Care, Sleep and Allergy, Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, USA
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23
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Abstract
Uveitis describes a group of inflammatory conditions of the eye that have various underlying causes and clinical presentations. Susceptibilities to uveitis in the elderly may be attributed to age-related risk factors such as immunosenescence, increased immunological inflammatory mediators, and autoimmunity. Overall, anterior uveitis is more common than posterior and panuveitis in the general population and also in the elderly. Some causes of uveitis in the elderly are herpes simplex virus, ocular ischemic syndrome, sarcoidosis, and central nervous system lymphoma, and these will be discussed in detail herein. Eye care professionals need to consider the wide differential for uveitis, obtain the appropriate history, conduct a detailed clinical examination, and tailor management to the clinical presentation and underlying cause of disease. The challenges of polypharmacy and nonadherence in the elderly impact patient outcomes and must be taken into consideration when considering treatment.
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Affiliation(s)
| | - Raquel Goldhardt
- University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Veterans Administration Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA
| | - Anat Galor
- University of Miami Miller School of Medicine, Miami, FL, USA.
- Miami Veterans Administration Medical Center, Miami, FL, USA.
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA.
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24
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Waki H, Eguchi K, Toriumi S, Ikemoto T, Suzuki T, Fukushima N, Kario K. Isolated Cardiac Sarcoidosis Mimicking Arrhythmogenic Right Ventricular Cardiomyopathy. Intern Med 2018; 57:835-839. [PMID: 29225258 PMCID: PMC5891523 DOI: 10.2169/internalmedicine.9395-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/27/2017] [Indexed: 11/06/2022] Open
Abstract
The diagnosis of cardiac sarcoidosis (CS) has become easier due to advances in imaging modalities, but we sometimes encounter difficult-to-diagnose patients. We herein report the case of a 60-year-old Japanese woman who was diagnosed with isolated CS, although she also met the diagnostic criteria of arrhythmogenic right ventricular cardiomyopathy (ARVC). A histological examination by an endomyocardial biopsy of the right ventricle revealed the typical findings of granulomatous change for CS. Although she did not show any characteristics of systemic sarcoidosis, oral prednisolone treatment was introduced, and she achieved a good response. This case shows that the characteristics of CS can overlap with the diagnostic criteria of ARVC, and that a histological examination is essential for the correct diagnosis of CS.
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Affiliation(s)
- Hirotaka Waki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Shinichi Toriumi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Tomokazu Ikemoto
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Tsukasa Suzuki
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Japan
| | - Noriyoshi Fukushima
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
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Eugénio G, Tavares J, Marques M, Duarte C, da Silva JAP. Just a painful swelling of the ankles? BMJ 2018. [PMID: 29523539 DOI: 10.1136/bmj.k436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gisela Eugénio
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - Mary Marques
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Cátia Duarte
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - J A P da Silva
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Abstract
Cardiac sarcoidosis is one of the uncommon causes of heart failure. Generally, it presents in the form of varying clinical manifestations ranging from asymptomatic to fatal arrhythmias such as ventricular tachycardia and complete heart block. It is difficult to make a diagnosis strictly based on clinical grounds. However, in the setting of extracardiac sarcoidosis and patients presenting with advanced heart block or ventricular arrhythmia, direct cardiac involvement should be suspected. The definitive diagnosis of cardiac sarcoidosis can be made from endomyocardial biopsy, but it is falling out of favor due to patchy myocardial involvement, considerable procedure-related risks, and advancement in additional imaging modalities. Once cardiac sarcoidosis has been diagnosed, management of the disease remains challenging. Steroids are considered the mainstay of therapy, and implantable cardioverter defibrillator therapy can be considered in a selected group of patients at greater risk for malignant ventricular arrhythmias.
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Affiliation(s)
- Brijesh Patel
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, USA.
| | - Mahek Shah
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, USA
| | - Alehegn Gelaye
- Department of Pulmonary and Critical Care, Providence-Providence Park Hospital, Southfield, MI, USA
| | - Raman Dusaj
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, USA
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Abstract
A 77-year-old Japanese woman presented with asymptomatic abdominal lymphadenopathy. Soluble interleukin-2 receptor (sIL2R) and angiotensin-converting enzyme (ACE) levels were elevated, and a pathological examination of lymph-node biopsies revealed non-caseating granulomas, which was consistent with sarcoidosis. Fluorodeoxyglucose-positron emission tomography did not show a clear accumulation in the mediastinal lymph-nodes or heart. Five months later, she presented with acute progressive heart failure that was refractory to conventional treatment. Her sIL2R and ACE levels decreased spontaneously over time, without steroid treatment. Autopsy findings revealed non-caseating granulomas. Cardiac sarcoidosis presenting as acute, progressive, treatment-refractory heart failure is rare. Steroid therapy after the resolution of inflammation did not affect the clinical outcome.
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Affiliation(s)
- Satoshi Oka
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Japan
| | - Ken Umetani
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Japan
| | - Tomoko Harama
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Japan
| | - Takuya Shimizu
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Japan
| | - Aritaka Makino
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Japan
| | - Keita Sano
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Japan
| | - Masahiko Nakamura
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Japan
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What Is Sarcoidosis? Am J Respir Crit Care Med 2018; 197:P3. [PMID: 29388823 DOI: 10.1164/rccm.1973P3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Kostorz S, Jastrzębski D, Sikora M, Zebrowska A, Margas A, Stepanik D, Swinder H, Ziora D. Predominance of Comorbidities in the Detriment of Daily Activity in Sarcoidosis Patients. Adv Exp Med Biol 2018; 1040:7-12. [PMID: 28804812 DOI: 10.1007/5584_2017_87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Sarcoidosis may affect lung function, working ability, overall mobility, and daily activity. In the present study we performed an analysis of clinical settings in patients with sarcoidosis to disentangle its influence on daily physical activity (PA). PA assessment (number of steps per day, daily energy expenditure) was performed by accelerometry during consecutive 7 days after discharge from hospital. Thirty patients with sarcoidosis, aged 46.4 ± 10.5, were enrolled in the study. Clinical data (age, gender, steroid consumption, weight, and comorbidities), lung function tests (forced expiratory volume in one second - FEV1, forced vital capacity - FVC, and lung diffusion for carbon monoxide - DLCO), mobility (6-minute walk test - 6 MWT) and physical performance (oxygen consumption at anaerobic threshold - VO2/AT) were estimated. The mean daily PA (5214 ± 2699 steps/day) and VO2max (22.3 ± 7.0 ml/kg/min) were lower when referenced to the age-group predicted values. A significant greater daily PA was observed in sarcoidosis patients without comorbidities compared with those having more than two comorbidities (p = 0.046). No association was found between steroid use, lung function, and 6MWT. Daily PA was associated with patients aerobic efficacy and VO2max (r = 0.38, p < 0.04). The findings demonstrate a significant influence of comorbidities on sarcoidosis patients' exercise tolerance and daily PA. Special treatment considerations, including the potential impact of comorbidities, may help optimize exercise regimes, link physical activity with health, and prevent sarcoidosis complications.
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Affiliation(s)
- S Kostorz
- School of Medicine with the Division of Dentistry, Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 1 Koziołka Street, 41-803, Zabrze, Poland
| | - D Jastrzębski
- School of Medicine with the Division of Dentistry, Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 1 Koziołka Street, 41-803, Zabrze, Poland.
| | - M Sikora
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, 40-065, Katowice, Poland
| | - A Zebrowska
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, 40-065, Katowice, Poland
| | - A Margas
- School of Medicine with the Division of Dentistry, Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 1 Koziołka Street, 41-803, Zabrze, Poland
| | - D Stepanik
- School of Medicine with the Division of Dentistry, Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 1 Koziołka Street, 41-803, Zabrze, Poland
| | - H Swinder
- School of Medicine with the Division of Dentistry, Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 1 Koziołka Street, 41-803, Zabrze, Poland
| | - D Ziora
- School of Medicine with the Division of Dentistry, Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 1 Koziołka Street, 41-803, Zabrze, Poland
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Pilzak K, Żebrowska A, Sikora M, Hall B, Łakomy O, Kostorz S, Ziora D, Jastrzębski D. Physical Functioning and Symptoms of Chronic Fatigue in Sarcoidosis Patients. Adv Exp Med Biol 2018; 1040:13-21. [PMID: 29067627 DOI: 10.1007/5584_2017_85] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
Scientific reports underscore the importance of measuring the health-related quality of life in sarcoidosis patients. The present study seeks to define how sarcoidosis patients' quality of life, daily physical activity, and physical performance are related to each other. Seventeen patients (mean age 46.8 ± 8.8 years) suffering from sarcoidosis completed the following questionnaires: the fatigue assessment scale (FAS), the quality of life scale (SF-36 questionnaire), and the Borg dyspnea scale. Physical activity (PA) was assessed using accelerometry. Respiratory function, consisting of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory volume in one second as a percentage of vital capacity (FEV1/%FVC), and diffusing capacity of the lungs for carbon monoxide (DLCO), were assessed. In addition, performance in 6-min walk test (MWT), aerobic capacity assessed from maximal oxygen uptake (VO2max), and the metabolic equivalent of task (MET) were evaluated. We found that daily PA (4566 ± 2378 steps/day) and VO2max (21.8 ± 5.9 ml/kg/min) were lower in sarcoidosis patients than the known predicted values in healthy age-matched individuals. There were significant inverse associations between the FAS score and 6MWT (r = -0.62; p < 0.01), and between SF-36 score and 6MWT (r = -0.55; p < 0.03). In contrast, SF-36 scores associated with fatigue and dyspnea scores (r = 0.72; p < 0.001 and r = 0.85; p < 0.001). These findings imply that sarcoidosis patients are less active compared with healthy subjects. The FAS and SF-36 scales seem to be effective tools for assessing the severity of fatigue in sarcoidosis patients.
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Affiliation(s)
- K Pilzak
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, 40-065, Katowice, Poland
| | - A Żebrowska
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, 40-065, Katowice, Poland.
| | - M Sikora
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, 40-065, Katowice, Poland
| | - B Hall
- School of Health Sciences, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, England, UK
| | - O Łakomy
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, 40-065, Katowice, Poland
| | - S Kostorz
- School of Medicine with the Division of Dentistry, Department of Lung Disease and Tuberculosis, Medical University of Silesia, 1 Koziołka St, 41-803, Zabrze, Poland
| | - D Ziora
- School of Medicine with the Division of Dentistry, Department of Lung Disease and Tuberculosis, Medical University of Silesia, 1 Koziołka St, 41-803, Zabrze, Poland
| | - D Jastrzębski
- School of Medicine with the Division of Dentistry, Department of Lung Disease and Tuberculosis, Medical University of Silesia, 1 Koziołka St, 41-803, Zabrze, Poland
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Abstract
RATIONALE The usual presentation of sarcoidosis is hilar adenopathy, pulmonary reticular opacities, skin, joint, or eye lesions. Pancreatic involvement is unusual and hypercalcemic pancreatitis as initial manifestation is very rare. PATIENT CONCERNS We present a case that presented with 1-day history of vomiting, diffuse abdominal pain, and altered mental status. DIAGNOSES Initial investigations showed highly elevated calcium levels, acute pancreatitis, and kidney failure. Possible causes entertained were malignancy, hyperparathyroidism, hypervitaminosis D, and granulomatous diseases. Full work-up including a hilar lymph node biopsy revealed noncaseating granuloma. After excluding other diseases capable of producing a similar picture, a diagnosis of sarcoidosis was made. INTERVENTIONS AND OUTCOMES The patient was started on aggressive intravenous fluid hydration and intravenous calcitonin, after which her altered mental status resolved and both kidney function and hypercalcemia improved. The patient was discharged on oral prednisone and serum calcium level normalized with progressive improvement of kidney function at follow-up. LESSONS The current case highlights the need for a high index of suspicion for this condition in patients who present with acute pancreatitis, as steroids are the treatment of choice. Thus, prompt recognition of this entity is of therapeutic significance.
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Affiliation(s)
| | - Alem Mehari
- Department of Internal Medicine
- Division of Pulmonary Diseases, Howard University College of Medicine, Washington, DC, USA
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Powell E, Rosen T. Ulcerative sarcoidosis: a prototypical presentation and review. Cutis 2017; 100:312-316. [PMID: 29232421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although rare, ulcerative sarcoidosis is an acknowledged morphologic variant of cutaneous sarcoidosis encountered in both the United States and worldwide, particularly in patients with skin of color. Herein, we present a patient with prototypical ulcerative sarcoidosis to highlight this unusual presentation of a relatively rare cutaneous condition. We also review 34 additional cases drawn from the English-language literature to define historical presentation, associated findings, treatments, and outcomes.
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Affiliation(s)
- Emily Powell
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ted Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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Saito H, Ohmori M, Iwamuro M, Tanaka T, Wada N, Yasunaka T, Takaki A, Okada H. Hepatic and Gastric Involvement in a Case of Systemic Sarcoidosis Presenting with Rupture of Esophageal Varices. Intern Med 2017; 56:2583-2588. [PMID: 28883247 PMCID: PMC5658523 DOI: 10.2169/internalmedicine.8768-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 46-year-old woman presented with massive hematemesis, caused by the rupture of esophageal varices. The laboratory investigations showed pancytopenia, and imaging tests revealed hepatosplenomegaly and ascites. A diagnosis of systemic sarcoidosis was made based on biopsies of the liver, stomach, lungs, heart, and skin. Although fat deposition was predominant, non-caseating granuloma and cirrhotic changes were found in the liver. Non-caseating granuloma was also identified in a biopsy specimen from minute depressions of the gastric folds. This case illustrates the rare involvement of the digestive system in a case of systemic sarcoidosis.
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Affiliation(s)
- Hiroaki Saito
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
- Saito Clinic, Japan
| | - Masayasu Ohmori
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | | | - Nozomu Wada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tetsuya Yasunaka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Asakawa N, Uchida K, Sakakibara M, Omote K, Noguchi K, Tokuda Y, Kamiya K, Hatanaka KC, Matsuno Y, Yamada S, Asakawa K, Fukasawa Y, Nagai T, Anzai T, Ikeda Y, Ishibashi-Ueda H, Hirota M, Orii M, Akasaka T, Uto K, Shingu Y, Matsui Y, Morimoto SI, Tsutsui H, Eishi Y. Immunohistochemical identification of Propionibacterium acnes in granuloma and inflammatory cells of myocardial tissues obtained from cardiac sarcoidosis patients. PLoS One 2017; 12:e0179980. [PMID: 28686683 PMCID: PMC5501515 DOI: 10.1371/journal.pone.0179980] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/07/2017] [Indexed: 12/28/2022] Open
Abstract
Background Although rare, cardiac sarcoidosis (CS) is potentially fatal. Early diagnosis and intervention are essential, but histopathologic diagnosis is limited. We aimed to detect Propionibacterium acnes, a commonly implicated etiologic agent of sarcoidosis, in myocardial tissues obtained from CS patients. Methods and results We examined formalin-fixed paraffin-embedded myocardial tissues obtained by surgery or autopsy and endomyocardial biopsy from patients with CS (n = 26; CS-group), myocarditis (n = 15; M-group), or other cardiomyopathies (n = 39; CM-group) using immunohistochemistry (IHC) with a P. acnes-specific monoclonal antibody. We found granulomas in 16 (62%) CS-group samples. Massive (≥14 inflammatory cells) and minimal (<14 inflammatory cells) inflammatory foci, respectively, were detected in 16 (62%) and 11 (42%) of the CS-group samples, 10 (67%) and 10 (67%) of the M-group samples, and 1 (3%) and 18 (46%) of the CM-group samples. P. acnes-positive reactivity in granulomas, massive inflammatory foci, and minimal inflammatory foci were detected in 10 (63%), 10 (63%), and 8 (73%) of the CS-group samples, respectively, and in none of the M-group and CM-group samples. Conclusions Frequent identification of P. acnes in sarcoid granulomas of originally aseptic myocardial tissues suggests that this indigenous bacterium causes granuloma in many CS patients. IHC detection of P. acnes in massive or minimal inflammatory foci of myocardial biopsy samples without granulomas may be useful for differentiating sarcoidosis from myocarditis or other cardiomyopathies.
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Affiliation(s)
- Naoya Asakawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Keisuke Uchida
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
- * E-mail:
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Keiji Noguchi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Yusuke Tokuda
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Kanako C. Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan
| | - Shiro Yamada
- Department of Cardiovascular Medicine, Otaru-kyokai Hospital, Hokkaido, Japan
| | - Kyoko Asakawa
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Hokkaido, Japan
| | - Yuichiro Fukasawa
- Department of Pathology, Sapporo City General Hospital, Hokkaido, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Masanori Hirota
- Department of Cardiovascular Surgery, Machida Municipal Hospital, Tokyo, Japan
| | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kenta Uto
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Shin-ichiro Morimoto
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyusyu University, Fukuoka, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Zhou T, Casanova N, Pouladi N, Wang T, Lussier Y, Knox KS, Garcia JGN. Identification of Jak-STAT signaling involvement in sarcoidosis severity via a novel microRNA-regulated peripheral blood mononuclear cell gene signature. Sci Rep 2017; 7:4237. [PMID: 28652588 PMCID: PMC5484682 DOI: 10.1038/s41598-017-04109-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/10/2017] [Indexed: 11/28/2022] Open
Abstract
Sarcoidosis is a granulomatous lung disorder of unknown cause. The majority of individuals with sarcoidosis spontaneously achieve full remission (uncomplicated sarcoidosis), however, ~20% of sarcoidosis-affected individuals experience progressive lung disease or cardiac and nervous system involvement (complicated sarcoidosis). We investigated peripheral blood mononuclear cell (PBMC) microRNA and protein-coding gene expression data from healthy controls and patients with uncomplicated or complicated sarcoidosis. We identified 46 microRNAs and 1,559 genes that were differentially expressed across a continuum of sarcoidosis severity (healthy control → uncomplicated sarcoidosis → complicated sarcoidosis). A total of 19 microRNA-mRNA regulatory pairs were identified within these deregulated microRNAs and mRNAs, which consisted of 17 unique protein-coding genes yielding a 17-gene signature. Pathway analysis of the 17-gene signature revealed Jak-STAT signaling pathway as the most significantly represented pathway. A severity score was assigned to each patient based on the expression of the 17-gene signature and a significant increasing trend in the severity score was observed from healthy control, to uncomplicated sarcoidosis, and finally to complicated sarcoidosis. In addition, this microRNA-regulated gene signature differentiates sarcoidosis patients from healthy controls in independent validation cohorts. Our study suggests that PBMC gene expression is useful in diagnosis of sarcoidosis.
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Affiliation(s)
- Tong Zhou
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, 89557, USA
| | - Nancy Casanova
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, 78721, USA
| | - Nima Pouladi
- Center for Bioinformatics and Biostatistics, University of Arizona Health Sciences, Tucson, AZ, 78721, USA
| | - Ting Wang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, 78721, USA
| | - Yves Lussier
- Center for Bioinformatics and Biostatistics, University of Arizona Health Sciences, Tucson, AZ, 78721, USA
| | - Kenneth S Knox
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, 78721, USA
| | - Joe G N Garcia
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, 78721, USA.
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Abstract
Radiofrequency catheter ablation (RFCA) is an important treatment modality to prevent ventricular tachycardia (VT) recurrence in patients with repaired congenital heart disease. Identification and ablation of anatomic isthmuses has improved acute ablation outcome with excellent VT-free survival in those with preserved biventricular function. Reports on RFCA for VT in patients with infiltrative disease are sparse and cardiac sarcoidosis seems to be the most prevalent cause for ventricular arrhythmia. Patients with active and ongoing inflammation are at high risk for VT recurrence. RFCA reduces the number of VT but often multiple procedures are required and long-term VT-free survival is unfavorable in those with left ventricular dysfunction.
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Affiliation(s)
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Gómez-Verdú JM, Valero Cifuentes S, Pastor Quirante F, López-Andreu FR. Acute sarcoid myopathy: a case report and literature review. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:413-415. [PMID: 28079855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 06/06/2023]
Abstract
Sarcoidosis is a worldwide spread disease with brad clinical spectrum, in which the pulmonary involvement is the main manifestation (more than 90% of cases); nevertheless, extrathoracic symptoms can predominate in the clinical picture and they may even be the first manifestation. One of them is the skeletal muscle involvement that normally is chronic and silent, with poor response to treatment with glucocorticoids. However, in some cases, it has an acute presentation. We present a case of a 61-year-old man with diagnosis of sarcoidosis whe were evaluated for proximal lower limb weakness within few days of evolution.
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38
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Rochat TS, Janssens JP, Soccal PM, Adler D. [Update on the treatment of sarcoidosis]. Rev Med Suisse 2016; 12:1966-1971. [PMID: 28696638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sarcoidosis is a granulomatous disease characterized by variable manifestations and course. About 50% of patients will require systemic treatment, while the remaining will present spontaneous resolution of the disease. When a systemic therapy is necessary, it is prolonged and relapse rate is high when it is discontinued. Systemic corticosteroids are the first line treatment in sarcoidosis. Because of many side effects, it is essential to consider other drugs in case of intolerance to steroids, as steroid-sparing agents, or in case of inefficiency of corticotherapy alone.
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Affiliation(s)
| | - Jean-Paul Janssens
- Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Paola M Soccal
- Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Dan Adler
- Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14
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Sekihara T, Nakane E, Nakasone K, Inoko M. Ventricular fibrillation via torsade des pointes of cardiac sarcoidosis with preserved left ventricular ejection fraction. BMJ Case Rep 2016; 2016:bcr2016216936. [PMID: 27797880 PMCID: PMC5093745 DOI: 10.1136/bcr-2016-216936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 11/04/2022] Open
Abstract
Generally, low left ventricular ejection fraction (LVEF) is a risk for ventricular arrhythmia in patients with cardiac sarcoidosis. We present a case of cardiac sarcoidosis with preserved LVEF that evoked ventricular fibrillation (VF). A 73-year-old woman with VF presented to our emergency department. She had a history of ocular sarcoidosis, with gradual thinning of the basal intraventricular septum. LVEF was 62% on the most recent echocardiography. The electrocardiogram after defibrillation showed complete atrioventricular block (CAVB) with QT segment prolongation and frequent ventricular premature beats. VF via torsade des pointes (TdP) was suspected, and temporary intravenous ventricular pacing and magnesium sulfate infusion suppressed her VF. Cardiac sarcoidosis was diagnosed, and an implantable cardioverter defibrillator was implanted. Patients with cardiac sarcoidosis with CAVB are at risk of evoking VF via TdP regardless of LVEF. If cardiac sarcoidosis is suspected, early diagnosis and risk stratification of ventricular arrhythmia are important.
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Affiliation(s)
- Takayuki Sekihara
- Cardiovascular Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Eisaku Nakane
- Cardiovascular Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kazutaka Nakasone
- Cardiovascular Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
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Aktop Z, Tanrıverdi H, Uygur F, İşleyen A, Kalaycı B, Gursoy YC, Karabağ T, Aydın M, Akpınar I. Diurnal characteristics of heart rate variability in patients with sarcoidosis. Herz 2016; 42:498-504. [PMID: 27738722 DOI: 10.1007/s00059-016-4486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/08/2016] [Accepted: 09/04/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate autonomic nervous system function by measuring heart rate variability (HRV) in patients with sarcoidosis without known cardiac manifestations. PATIENTS AND METHODS The study comprised 61 participants, including 31 patients with sarcoidosis without known cardiac manifestations and 30 healthy volunteers. All participants underwent echocardiographic examination, 12-channel electrocardiography (ECG), and 24-h Holter monitoring. HRV parameters were determined and compared between the groups. RESULTS There were no differences between groups with regard to age, body mass index, systolic and diastolic blood pressure, or heart rate at the time of admission. In the time domain analyses, the 24-h, daytime, and night-time standard deviations of all normal-to-normal R‑R interval (SDNN) values were significantly lower in patients with sarcoidosis than those in the controls. The frequency domain analyses showed that 24-h and daytime low-frequency (LF) values, 24-h, daytime, and night-time high-frequency (HF) values were significantly lower in the patient group compared with the control group, whereas the night-time LF/HF ratio was significantly higher. CONCLUSION Although Holter ECG is not a diagnostic tool for cardiac sarcoidosis, the HRV parameters, especially the night-time LF/HF values, may demonstrate increased sympathetic activation in patients with sarcoidosis.
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Affiliation(s)
- Z Aktop
- Faculty of Medicine, Department of Cardiology, Bülent Ecevit University, 67600, Kozlu/Zonguldak, Turkey.
| | - H Tanrıverdi
- Faculty of Medicine, Department of Pulmonary Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - F Uygur
- Faculty of Medicine, Department of Pulmonary Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - A İşleyen
- Faculty of Medicine, Department of Cardiology, Bülent Ecevit University, 67600, Kozlu/Zonguldak, Turkey
| | - B Kalaycı
- Faculty of Medicine, Department of Cardiology, Bülent Ecevit University, 67600, Kozlu/Zonguldak, Turkey
| | - Y C Gursoy
- Faculty of Medicine, Department of Cardiology, Bülent Ecevit University, 67600, Kozlu/Zonguldak, Turkey
| | - T Karabağ
- Faculty of Medicine, Department of Cardiology, Bülent Ecevit University, 67600, Kozlu/Zonguldak, Turkey
| | - M Aydın
- Faculty of Medicine, Department of Cardiology, Bülent Ecevit University, 67600, Kozlu/Zonguldak, Turkey
| | - I Akpınar
- Faculty of Medicine, Department of Cardiology, Bülent Ecevit University, 67600, Kozlu/Zonguldak, Turkey
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Ungprasert P, Crowson CS, Matteson EL. Smoking, obesity and risk of sarcoidosis: A population-based nested case-control study. Respir Med 2016; 120:87-90. [PMID: 27817820 DOI: 10.1016/j.rmed.2016.10.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/21/2016] [Accepted: 10/10/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Smoking and obesity might alter the risk of sarcoidosis. However, the data remained inconclusive. METHODS A cohort of Olmsted County, Minnesota residents diagnosed with sarcoidosis between January 1, 1976 and December 31, 2013 was identified based on individual medical record review. For each sarcoidosis subject, one sex and aged-matched control without sarcoidosis was randomly selected from the same underlying population. Medical records of cases and controls were reviewed for smoking status at index date and body mass index (BMI) within 1 year before to 3 months after index date. RESULTS 345 incident cases of sarcoidosis and 345 controls were identified. The odds ratio of sarcoidosis comparing current smokers with never smokers adjusted for age and sex was 0.34 (95% confidence interval (CI), 0.23-0.50). The odds ratio of sarcoidosis comparing current smokers with never smokers and former smokers adjusted for age and sex was 0.38 (95% CI, 0.26-0.56). The odds ratio of sarcoidosis comparing overweight subjects (BMI ≥ 25 kg/m2 but < 30 kg/m2) with subjects with normal/low BMI was 1.12 (95% CI, 0.72-1.75). The odds ratio of sarcoidosis comparing obese subjects (BMI ≥ 30 kg/m2) with subjects with normal/low BMI was 2.54 (95% CI, 1.58-4.06). The odds ratio of sarcoidosis comparing obese subjects with non-obese subjects was 2.38 (95% CI, 1.60-3.56). CONCLUSION In this population, current smokers have a lower risk of developing sarcoidosis while subjects with obesity have a higher risk of developing sarcoidosis.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA; Division of Biomedical Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA; Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN 55905, USA
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Kingah P, Alam M, Chugh K, Kamholz J, Samavati L. Role of Pulmonary Evaluation in Diagnosis of Neurosarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:209-215. [PMID: 27758985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/03/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neurosarcoidosis is a serious extra pulmonary manifestation of sarcoidosis. Its presentation ranges from peripheral or cranial neuropathy to central nervous system dysfunction. It can mimic stroke or multiple sclerosis. Due to the variation in clinical presentation, diagnosis is difficult and often delayed. OBJECTIVE Determine the proportion of patients with neurosarcoidosis who have positive findings on chest CT, lung biopsy or lymph node biopsy. METHODS Retrospective study at the Sarcoidosis and Interstitial Lung Disease Center at Wayne State University-Detroit Medical Center in Detroit, MI. Medical records of 424 patients were reviewed and 69 patients with neurosarcoidosis identified. RESULTS We found that most patients diagnosed with neurosarcoidosis had normal PFT values except for reduction in DLCO. However, we also found that 71% of the patients had abnormal findings on chest CT consistent with sarcoidosis. Additionally, 57% of the patients had non-caseating granuloma on hilar lymph node biopsy. CONCLUSION Patients with neurosarcoidosis may not have any pulmonary symptoms. However, they are most likely to have abnormal chest CT, hilar lymphadenopathy and reduction in DLCO. These data suggest that pulmonary evaluation is warranted in patients who are suspected to have neurosarcoidosis.
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Erthal F, Juneau D, Lim SP, Dwivedi G, Nery PB, Birnie D, Beanlands RS. Imaging of cardiac sarcoidosis. Q J Nucl Med Mol Imaging 2016; 60:252-263. [PMID: 27225318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sarcoidosis is a multisystem inflammatory disease. Cardiac involvement is described in up to 50% of the cases. The disease spectrum is wide and cardiac manifestations ranges from being asymptomatic to heart failure, arrhythmias and sudden cardiac death. The diagnosis of cardiac sarcoidosis can be challenging due to its non-specific nature and the focal involvement of the heart. In this review, we discuss the utility of a stepwise approach with multimodality cardiac imaging in the diagnosis and management of CS.
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Affiliation(s)
- Fernanda Erthal
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre and Electrophysiology Section, University of Ottawa Heart Institute, Ottawa, Canada -
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Sexton DJ, O'Reilly MW, Geoghegan P, Kinsella SM, Moran PJ, O'Regan AW. Serum fibroblastic growth factor 23 in acute Sarcoidosis and normal kidney function. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:139-142. [PMID: 27537716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/30/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND Serum fibroblastic growth factor (FGF) 23 has recently been established as a major physiological regulator of phosphate homeostasis and may have a causal role in adverse cardiovascular and bone outcomes. However its role in states of disordered phosphate homeostasis and normal kidney function is as yet under characterised. AIMS To investigate whether this biomarker of vascular calcification and adverse bone outcomes is detectable in patients with sarcoidosis. DESIGN We conducted a cross sectional study on a convenience sample of patients presenting with acute sarcoidosis to a respiratory tertiary referral unit. METHODS We set out to systematically examine the characteristics and determinants of serum FGF-23 in patients presenting with acute sarcoidosis. RESULTS We studied 39 patients, 26 were male. Mean (SD) age was 33 (9.6) years. 15.4% of patients had a serum level of FGF-23 ≥ 9.9 pg/mL. The remaining 84.6% of patients had a serum FGF-23 < 9.9 pg/mL. Those with a detectable serum FGF-23 had a significantly higher serum calcium (P = 0.007), and lower serum iPTH (P<0.001). Serum phosphate and 25-hydroxyvitamin D were not statistically significantly different between groups (P=0.25 and P=0.83). The proportion of patients with stage II disease on CXR was higher in those with a detectable FGF-23 (P<0.001). CONCLUSIONS Serum FGF-23 was below the level of detection in the majority of this cohort of patients presenting with acute sarcoidosis. A detectable serum FGF-23 was associated with a higher serum calcium and lower serum iPTH.
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Abgral R, Dweck MR, Trivieri MG, Robson PM, Karakatsanis N, Mani V, Padilla M, Miller M, Lala A, Sanz J, Narula J, Fuster V, Contreras J, Kovacic JC, Fayad ZA. Clinical Utility of Combined FDG-PET/MR to Assess Myocardial Disease. JACC Cardiovasc Imaging 2016; 10:594-597. [PMID: 27372018 DOI: 10.1016/j.jcmg.2016.02.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Ronan Abgral
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Nuclear Medicine, European University of Brittany, EA3878 GETBO, CHRU Brest, Brest, France
| | - Marc R Dweck
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Maria Giovanna Trivieri
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip M Robson
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicolas Karakatsanis
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Padilla
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marc Miller
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anuradha Lala
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Javier Sanz
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jagat Narula
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johanna Contreras
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason C Kovacic
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Porretta AP, Van der Gucht A, Bisch L, Mitsakis P, Pomoni A, Allenbach G, Lalonde MN, Schaefer N, Buss G, Prior JO, Pruvot É. [Cardiac sarcoidosis: seven keypoints to remind in order to avoid misdiagnosis]. Rev Med Suisse 2016; 12:1035-1041. [PMID: 27424343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Early diagnosis of cardiac sarcoidosis remains difficult in the absence of specific symptoms. The evolution and prognosis of the disease are strongly correlated to an early and appropriate treatment. The multi-modality assessment based on cardiac MRI and positron emission tomography associated with computed tomography (PET/CT) has significantly improved the detection of cardiac sarcoidosis over the last two decades. These approaches appear as useful and suitable imaging strategy for the early diagnosis, the assessment of the disease extent as well as the management and therapeutic follow-up. This article is a didactic review on cardiac sarcoidosis, with a special focus on recent diagnostic and therapeutic modalities, prognosis and interest of imaging techniques.
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Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL. Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Mayo Clin Proc 2016; 91:183-8. [PMID: 26727158 PMCID: PMC4744129 DOI: 10.1016/j.mayocp.2015.10.024] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the epidemiology of sarcoidosis from 1946 through 2013. PATIENTS AND METHODS An inception cohort of patients with incident sarcoidosis from January 1, 1976, through December 31, 2013, in Olmsted County, Minnesota, was identified based on comprehensive individual medical record review. Inclusion required physician diagnosis supported by histopathologic confirmation, radiologic features of intrathoracic sarcoidosis, and a compatible clinical presentation. Data were collected on demographic characteristics, clinical presentation, laboratory investigations, and mortality. The data were augmented with a previously identified cohort of Olmsted County residents diagnosed as having sarcoidosis in 1946-1975. Incidence rates were age and sex adjusted to the 2010 US white population. RESULTS A total of 448 incident cases of sarcoidosis were identified (mean age, 44.2 years; 52% women). The annual incidence of sarcoidosis was 10.0 per 100,000 population. The incidence of sarcoidosis increased in women from 1950 to 1960, but otherwise there were no significant calendar year trends. However, the peak age at incidence for women shifted from 40 to 59 years in 1950 to 50 to 69 years in 2010. Similarly, the peak age at incidence for men shifted from 30 to 49 years in 1950 to 40 to 59 years in 2010. Ninety-seven percent of patients had intrathoracic involvement, but only 43% had respiratory symptoms. The overall mortality of patients with sarcoidosis was not different from that of the general population (standardized mortality ratio=0.90; 95% CI, 0.74-1.08). CONCLUSION Sarcoidosis occurred in approximately 10 persons per 100,000 per year. Most of the patients had intrathoracic involvement, although less than half had respiratory symptoms. Overall mortality was not different from that of the general population.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Eva M Carmona
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - James P Utz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, 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 Sciences 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 Sciences Research, Mayo Clinic, Rochester, MN
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Abstract
We herein describe a second Japanese case of sarcoidosis presenting Addison's disease. A 52-year-old man was diagnosed with sarcoidosis based on clinical and laboratory findings, including bilateral hilar lymphadenopathy and elevated levels of serum angiotensin-converting enzyme and lysozyme, as well as the presence of noncaseating epithelioid granulomas. The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency. This case suggests the direct involvement of sarcoid granuloma in the adrenal glands.
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Affiliation(s)
- Kentaro Takahashi
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Japan
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Agrawal R, Gonzalez-Lopez JJ, Meier F, Gupta B, Pavesio CE. Ocular and systemic features of sarcoidosis and correlation with the International Workshop for Ocular Sarcoidosis diagnostic criteria. Sarcoidosis Vasc Diffuse Lung Dis 2015; 32:237-245. [PMID: 26422569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/26/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To describe the ocular and systemic features in biopsy proven (definite) and non-biopsy proven (clinical) ocular sarcoidosis and to compare the ocular features with those proposed by the International Workshop for Ocular Sarcoidosis (IWOS). METHODS Retrospective chart review of 83 patients who attended a tertiary referral uveitis clinic and were diagnosed with sarcoidosis. Patients were divided into two groups based on the type of diagnosis: those who had tissue biopsy confirmed diagnosis 'definite sarcoidosis' (n= 42; 50.60 %) and those who had 'clinical sarcoidosis' (n= 41; 49.40%). Ocular and systemic manifestations, including lung function tests and bronchoalveolar lavage findings were compared in the two groups. The ocular features were also compared with the categories laid down by the International Workshop on Ocular Sarcoidosis (IWOS). RESULTS The mean age at presentation was 38.75 years (SD=12.33), 55.42% patients were female and mean follow-up was 24.35 months (SD=18.35). Trabecular meshwork nodules and/or tent-shaped PAS (category II of IWOS) were observed more frequently in patients with biopsy proven sarcoidosis (26.19 % v/s 9.76%; p=0.08). After logistic regression analysis, the predictor coefficient curve showed area under curve of 0.7262. Lymphocytosis (38.61% and 28.02%, p=0.93) and monocytosis (55.11% and 53.83%, p=0.56) on bronchoalveolar lavage analysis was present in both the groups, highlighting presence of granulomatous disease. CONCLUSION This study suggests high reliability for the clinical diagnosis of ocular sarcoidosis in patients with signs recommended by IWOS and that our diagnostic criteria are consistent with that of the IWOS.
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Affiliation(s)
- Rupesh Agrawal
- Consultant, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.
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50
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Abstract
Sarcoidosis is an idiopathic inflammatory disorder characterized by noncaseating granulomas, which can affect any organ system. The lungs are most commonly affected but extrapulmonary sites may cause the initial and/or sole symptoms. In this review, the disease manifestations and treatment are described, with particular emphasis on the management of each affected organ system. Diagnosis and management can be difficult and greatly affect quality of life, but despite these challenges, it is possible to successfully manage patients with sarcoidosis in the primary care setting.
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Affiliation(s)
- Justin Shinn
- Department of Internal Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98115, USA.
| | - Douglas S Paauw
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
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