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Chan JCK, Boland JM. Granulomatous Lung Diseases: A Practical Approach and Review of Common Entities. Surg Pathol Clin 2024; 17:173-192. [PMID: 38692803 DOI: 10.1016/j.path.2023.11.004] [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] [Indexed: 05/03/2024]
Abstract
Granulomas are frequently encountered by pathologists in all types of lung specimens and arise from diverse etiologies. They should always be reported as necrotizing or non-necrotizing, with microorganism stains performed to evaluate for infection. With attention to distribution, quality (poorly vs well-formed), associated features, and correlation with clinical, radiologic, and laboratory data, the differential diagnosis for granulomatous lung disease can usually be narrowed to a clinically helpful "short list." This review describes a practical approach to pulmonary granulomas and reviews the clinicopathological aspects of common entities, including infectious (mycobacteria, fungi) and noninfectious (hypersensitivity pneumonitis, sarcoid, and vasculitis) causes.
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Affiliation(s)
- Jackie Cheuk Ki Chan
- Department of Laboratory Medicine and Pathology, Royal Alexandra and University of Alberta Hospitals, 10240 Kingsway NW, Edmonton, Alberta, Canada, T5H 3V9
| | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Miedema JR, de Jong LJ, Kahlmann V, Bergen IM, Broos CE, Wijsenbeek MS, Hendriks RW, Corneth OBJ. Increased proportions of circulating PD-1 + CD4 + memory T cells and PD-1 + regulatory T cells associate with good response to prednisone in pulmonary sarcoidosis. Respir Res 2024; 25:196. [PMID: 38715030 PMCID: PMC11075187 DOI: 10.1186/s12931-024-02833-y] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The treatment response to corticosteroids in patients with sarcoidosis is highly variable. CD4+ T cells are central in sarcoid pathogenesis and their phenotype in peripheral blood (PB) associates with disease course. We hypothesized that the phenotype of circulating T cells in patients with sarcoidosis may correlate with the response to prednisone treatment. Therefore, we aimed to correlate frequencies and phenotypes of circulating T cells at baseline with the pulmonary function response at 3 and 12 months during prednisone treatment in patients with pulmonary sarcoidosis. METHODS We used multi-color flow cytometry to quantify activation marker expression on PB T cell populations in 22 treatment-naïve patients and 21 healthy controls (HCs). Pulmonary function tests at baseline, 3 and 12 months were used to measure treatment effect. RESULTS Patients with sarcoidosis showed an absolute forced vital capacity (FVC) increase of 14.2% predicted (± 10.6, p < 0.0001) between baseline and 3 months. Good response to prednisone (defined as absolute FVC increase of ≥ 10% predicted) was observed in 12 patients. CD4+ memory T cells and regulatory T cells from patients with sarcoidosis displayed an aberrant phenotype at baseline, compared to HCs. Good responders at 3 months had significantly increased baseline proportions of PD-1+CD4+ memory T cells and PD-1+ regulatory T cells, compared to poor responders and HCs. Moreover, decreased fractions of CD25+ cells and increased fractions of PD-1+ cells within the CD4+ memory T cell population correlated with ≥ 10% FVC increase at 12 months. During treatment, the aberrantly activated phenotype of memory and regulatory T cells reversed. CONCLUSIONS Increased proportions of circulating PD-1+CD4+ memory T cells and PD-1+ regulatory T cells and decreased proportions of CD25+CD4+ memory T cells associate with good FVC response to prednisone in pulmonary sarcoidosis, representing promising new blood biomarkers for prednisone efficacy. TRIAL REGISTRATION NL44805.078.13.
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Affiliation(s)
- Jelle R Miedema
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
| | - Lieke J de Jong
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Vivienne Kahlmann
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Ingrid M Bergen
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Caroline E Broos
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Marlies S Wijsenbeek
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Rudi W Hendriks
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Odilia B J Corneth
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
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Van Woensel J, Koopman B, Schiefer M, van Kan C, Janssen MTFH, Ramiro S, Magro-Checa C, Landewé RB, de Kruif MD, Bresser P, Mostard RLM. Organ involvement in newly diagnosed sarcoidosis patients in the Netherlands: The first large European multicentre prospective study. Respir Med 2024; 226:107608. [PMID: 38582302 DOI: 10.1016/j.rmed.2024.107608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Clinical presentation and prevalence of organ involvement is highly variable in sarcoidosis and depends on ethnic, genetic and geographical factors. These data are not extensively studied in a Dutch population. AIM To determine the prevalence of organ involvement and the indication for systemic immunosuppressive therapy in newly diagnosed sarcoidosis patients in the Netherlands. METHODS Two large Dutch teaching hospitals participated in this prospective cohort study. All adult patients with newly diagnosed sarcoidosis were prospectively included and a standardized work-up was performed. Organ involvement was defined using the WASOG instrument. RESULTS Between 2015 and 2020, a total of 330 patients were included, 55% were male, mean age was 46 (SD 14) years. Most of them were white (76%). Pulmonary involvement including thoracic lymph node enlargement was present in 316 patients (96%). Pulmonary parenchymal disease was present in 156 patients (47%). Ten patients (3%) had radiological signs of pulmonary fibrosis. Cutaneous sarcoidosis was present in 74 patients (23%). Routine ophthalmological screening revealed uveitis in 29 patients (12%, n = 256)). Cardiac and neurosarcoidosis were diagnosed in respectively five (2%) and six patients (2%). Renal involvement was observed in 11 (3%) patients. Hypercalcaemia and hypercalciuria were observed in 29 (10%) and 48 (26%, n = 182) patients, respectively. Hepatic involvement was found in 6 patients (2%). In 30% of the patients, systemic immunosuppressive treatment was started at diagnosis. CONCLUSIONS High-risk organ involvement in sarcoidosis is uncommon at diagnosis. Indication for systemic immunosuppressive therapy was present in a minority of patients.
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Affiliation(s)
- Julie Van Woensel
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands
| | - Bart Koopman
- Department of Respiratory Medicine, OLVG, Amsterdam, the Netherlands
| | - Mart Schiefer
- Department of Respiratory Medicine, ETZ, Tilburg, the Netherlands
| | - Coen van Kan
- Department of Respiratory Medicine, OLVG, Amsterdam, the Netherlands
| | - Marlou T F H Janssen
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg, the Netherlands; Department of Rheumatology, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - César Magro-Checa
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg, the Netherlands
| | - Robert Bm Landewé
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg, the Netherlands; Amsterdam Rheumatology Centre, AMC, Amsterdam, the Netherlands
| | - Martijn D de Kruif
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands
| | - Paul Bresser
- Department of Respiratory Medicine, OLVG, Amsterdam, the Netherlands
| | - Rémy L M Mostard
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen/Sittard, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
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Kraaijvanger R, Janssen Bonás M, Grutters JC, Paspali I, Veltkamp M, de Kleijn DPV, van Moorsel CHM. Decreased serpin C1 in extracellular vesicles predicts response to methotrexate treatment in patients with pulmonary sarcoidosis. Respir Res 2024; 25:166. [PMID: 38627696 PMCID: PMC11020913 DOI: 10.1186/s12931-024-02809-y] [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: 11/03/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disease of unknown etiology primarily affecting the lungs. Treatment is needed when disease symptoms worsen and organ function deteriorates. In pulmonary sarcoidosis, prednisone and methotrexate (MTX) are the most common anti-inflammatory therapies. However, there is large inter-patient variability in response to treatment, and predictive response markers are currently lacking. OBJECTIVE In this study, we investigated the predictive potential of biomarkers in extracellular vesicles (EVs) isolated from biobanked serum of patients with pulmonary sarcoidosis stored prior to start of therapy. METHODS Protein concentrations of a four-protein test panel of inflammatory proteins were measured in a discovery (n = 16) and replication (n = 129) cohort of patients with sarcoidosis and 47 healthy controls. Response to therapy was defined as an improvement of the absolute score of > 5% forced vital capacity (FVC) and/or > 10% diffusion lung of carbon monoxide (DLCO) after 24 weeks compared to baseline (before treatment). RESULTS Serum protein levels differed between EV fractions and serum, and between sarcoidosis cases and controls. Serpin C1 concentrations in the low density lipid particle EV fraction were lower at baseline in the group of patients with a good response to MTX treatment in both the discovery cohort (p = 0.059) and in the replication cohort (p = 0.032). EV Serpin C1 showed to be a significant predictor for response to treatment with MTX (OR 0.4; p = 0.032). CONCLUSION This study shows that proteins isolated from EVs harbor a distinct signal and have potential as new predictive therapy response biomarkers in sarcoidosis.
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Affiliation(s)
- Raisa Kraaijvanger
- Department of Pulmonology, St Antonius Hospital, Interstitial Lung Diseases Center of Excellence, Nieuwegein, The Netherlands
| | - Montse Janssen Bonás
- Department of Pulmonology, St Antonius Hospital, Interstitial Lung Diseases Center of Excellence, Nieuwegein, The Netherlands
| | - Jan C Grutters
- Department of Pulmonology, St Antonius Hospital, Interstitial Lung Diseases Center of Excellence, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
| | - Ioanna Paspali
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Marcel Veltkamp
- Department of Pulmonology, St Antonius Hospital, Interstitial Lung Diseases Center of Excellence, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
| | | | - Coline H M van Moorsel
- Department of Pulmonology, St Antonius Hospital, Interstitial Lung Diseases Center of Excellence, Nieuwegein, The Netherlands.
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Benzaquen S, Matta A, Sultan S, Sarvottam K. Role of Bronchoscopy in Diagnosis of Sarcoidosis. Clin Chest Med 2024; 45:25-32. [PMID: 38245368 DOI: 10.1016/j.ccm.2023.08.001] [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] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a multisystem inflammatory disorder with unclear etiology and can often pose a diagnostic challenge. A tissue diagnosis is often necessary to illustrate the non-caseating granulomas on histopathology. This review aims to synthesize current evidence related to tissue diagnosis of sarcoidosis using various bronchoscopic techniques. We start by discussing standard bronchoscopic techniques which have remained the cornerstone of diagnostic workup such as bronchoalveolar lavage (BAL), endobronchial biopsy (EBB), conventional transbronchial needle aspiration (cTBNA) and transbronchial lung biopsy (TBLB) followed by newer modalities that incorporate real-time image guidance using endobronchial and endoscopic ultrasound. Although BAL, EBB, and TBLB have been employed as a diagnostic tool for several decades, their sensitivity and diagnostic yield is inferior to ultrasound-based endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). More recently, convincing evidence has also emerged to support the diagnostic accuracy and tissue yield of transbronchial lung cryobiopsy which will also be discussed in this review. These advances in bronchoscopic equipment and techniques over the last 2 decades have made it possible to obtain tissue samples using minimally invasive techniques thus avoiding invasive open lung biopsy and the risks that inherently follow. Up-to-date knowledge of these modalities is imperative for ensuring evidence-based medicine and improving patient-centric outcomes.
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Affiliation(s)
- Sadia Benzaquen
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Atul Matta
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sahar Sultan
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kumar Sarvottam
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
This article focuses on the monitoring of pulmonary sarcoidosis. The monitoring of sarcoidosis is, in part, focused on serial change in major organ involvement but also includes diagnostic re-evaluation and review of change in quality of life. Recent criteria for progression of fibrotic interstitial lung disease are adapted to pulmonary sarcoidosis. The frequency and nature of monitoring are discussed, integrating baseline risk stratification and strategic treatment goals. Individual variables used to identify changes in pulmonary disease severity are discussed with a focus on their flaws and the need for a multidimensional approach. Other key monitoring issues are covered briefly.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease/Sarcoidosis Unit, Royal Brompton Hospital, Sydney street, London, SW3 6NP; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY.
| | - Athol Umfrey Wells
- Interstitial Lung Disease/Sarcoidosis Unit, Royal Brompton Hospital, Sydney street, London, SW3 6NP; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY
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Partin M, Clebak KT, Chen R, Helm M. Sarcoidosis: Evaluation and Treatment. Am Fam Physician 2024; 109:19-29. [PMID: 38227868] [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: 01/18/2024]
Abstract
Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown etiology that can involve any organ. Ongoing dyspnea and dry cough in a young to middle-aged adult should increase the suspicion for sarcoidosis. Symptoms can present at any age and affect any organ system; however, pulmonary sarcoidosis is the most common. Extrapulmonary manifestations often involve cardiac, neurologic, ocular, and cutaneous systems. Patients with sarcoidosis can exhibit constitutional symptoms such as fever, unintentional weight loss, and fatigue. The early recognition and diagnosis of sarcoidosis are challenging because there is no diagnostic standard for testing, initial symptoms vary, and patients may be asymptomatic. Consensus guidelines recommend a holistic approach when diagnosing sarcoidosis that focuses on clinical presentation and radiographic findings, biopsy with evidence of noncaseating granulomas, involvement of more than one organ system, and elimination of other etiologies of granulomatous disease. Corticosteroids are the initial treatment for active disease, with refractory cases often requiring immunosuppressive or biologic therapies. Transplantation can be considered for advanced and end-stage disease depending on organ involvement.
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Affiliation(s)
- Michael Partin
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Karl T Clebak
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rensa Chen
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew Helm
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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8
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Judson MA. Cough monitoring for pulmonary sarcoidosis. Respir Med 2024; 221:107483. [PMID: 38113960 DOI: 10.1016/j.rmed.2023.107483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, MC-91, Albany Medical College, Albany, NY 12208, USA.
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Lee JH, Han YE, Yang J, Kim HC, Lee J. Clinical manifestations and associated factors of uveitis in patients with pulmonary sarcoidosis: a case control study. Sci Rep 2023; 13:22380. [PMID: 38104161 PMCID: PMC10725472 DOI: 10.1038/s41598-023-49894-5] [Citation(s) in RCA: 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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023] Open
Abstract
Sarcoidosis, an idiopathic and inflammatory disease, affects various organs and can manifest as uveitis. Due to limited evidence, researchers investigated the risk factors associated with uveitis in patients with pulmonary sarcoidosis. A retrospective study was conducted on 71 pulmonary sarcoidosis patients, including 19 with uveitis and 52 without. Data on involved organs, imaging findings, spirometry, and analyses from blood and bronchoalveolar lavage fluid were collected. Logistic regression models were used for multivariate analysis. Among the 71 newly diagnosed pulmonary sarcoidosis patients, uveitis was observed in 19 patients (26.8%). No significant differences were found in clinical characteristics between patients with and without uveitis. Fewer patients with uveitis presented lung parenchymal lesions (P = 0.043). In multivariate analysis, skin lesions (aOR 7.619, 95% CI 1.277-45.472, P = 0.026) and ophthalmic symptoms (aOR 4.065, 95% CI 1.192-13.863, P = 0.025) were associated with uveitis. Absence of uveitis was related to lung parenchymal lesions (aOR 0.233, 95% CI 0.062-0.883, P = 0.032). Approximately one-quarter of patients with an initial diagnosis of pulmonary sarcoidosis were diagnosed with uveitis. Presence of skin lesions, ophthalmic symptoms, and absence of lung parenchymal lesions were related to uveitis. These results need to be clarified by further studies to confirm the clinical role of early ophthalmologic screening for pulmonary sarcoidosis patients with these factors.
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Affiliation(s)
- Jang Ho Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ye Eun Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jiyoul Yang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho Cheol Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Köycü Buhari G, Çiledağ A, Kurt İ, Çağlar E, Kaya A, Özdemir Kumbasar Ö, Çelik G. The role of serum and bronchoalveolar lavage fluid chitotriosidase activity on diagnosis, disease characteristics and prognosis of sarcoidosis. Tuberk Toraks 2023; 71:367-377. [PMID: 38152007 DOI: 10.5578/tt.20239605] [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] [Indexed: 12/29/2023] Open
Abstract
Introduction Sarcoidosis is a multisystem granulomatous disease with an unpredictable clinical course. Chitotriosidase is a chitinase mainly expressed by activated macrophages. Increased chitotriosidase activity has been reported in serum and bronchoalveolar lavage (BAL) of sarcoidosis patients compared to healthy controls. This study aims to evaluate the role of serum and BAL chitotriosidase activity on diagnosis, disease characteristics, and prognosis of sarcoidosis. Materials and Methods Patients referred with suspected sarcoidosis or other interstitial lung disease were prospectively included in the study. All patients underwent bronchoscopy with BAL. Serum and BAL chitotriosidase activity, BAL differential cell counts, and lymphocyte phenotypes were determined. Sarcoidosis patients were followed up regularly. Result Forty-two sarcoidosis and 28 non-sarcoidosis patients were included in the study. Serum chitotriosidase activity was higher in sarcoidosis group 247.5 (2.78-461) vs 108 (2.78-272) nmol/h/mL (p< 0.001). BAL chitotriosidase activity tended to be higher in sarcoidosis group 11 (2-308) vs 6.95 (2.27-44) nmol/h/mg but was not found to be statistically significant (p= 0.11). Serum and BAL chitotriosidase activities were correlated with each other (p= 0.023, r= 0.355). No significant difference was found between the diagnostic performance of BAL CD4/CD8 ratio and serum chitotriosidase activity (p= 0.079). Serum chitotriosidase and ACE activities were correlated with each other (p= 0.004, r= 0.457). No significant difference was found between serum or BAL chitotriosidase activity and stage or extrapulmonary involvement. Serum chitotriosidase activity was higher in patients who needed systemic therapy at diagnosis (p= 0.046). However, no significant difference was found between serum or BAL chitotriosidase activities and disease progression (p= 0.395 and p= 0.723, respectively). Conclusions Serum chitotriosidase activity can be helpful in the differential diagnosis of sarcoidosis with a similar diagnostic performance with BAL CD4/CD8 ratio. Although serum chitotriosidase activity at diagnosis does not predict progressive disease, it is associated with the need for systemic therapy at diagnosis. Serial chitotriosidase measurements may be useful in monitoring disease progression during follow-up.
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Affiliation(s)
- Gözde Köycü Buhari
- Department of Immunology and Allergy, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Aydın Çiledağ
- Department of Pulmonary Diseases, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - İsmail Kurt
- Department of Biochemistry (Retired Lecturer), Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Emel Çağlar
- Department of Biochemistry, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Akın Kaya
- Department of Pulmonary Diseases, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Özlem Özdemir Kumbasar
- Department of Pulmonary Diseases, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Gökhan Çelik
- Department of Pulmonary Diseases, Ankara University Faculty of Medicine, Ankara, Türkiye
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Gillissen A. [Update pulmonary sarcoidosis]. MMW Fortschr Med 2023; 165:50-53. [PMID: 37828333 DOI: 10.1007/s15006-023-2845-8] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Adrian Gillissen
- Medizinische Klinik III, Kreiskliniken Reutlingen, Steinenbergstraße 31, 72764, Reutlingen, Deutschland.
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12
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Jain R, Kumari R, Chakraborty S, Mitra DK, Mohan A, Hadda V, Madan K, Guleria R. T-cell signature cytokines distinguish pulmonary sarcoidosis from pulmonary tuberculosis. Eur J Immunol 2023; 53:e2250255. [PMID: 37505436 DOI: 10.1002/eji.202250255] [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: 11/14/2022] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023]
Abstract
Sarcoidosis is a systemic inflammatory disorder characterized by tissue infiltration due to mononuclear phagocytes and lymphocytes and associated noncaseating granuloma formation. Pulmonary sarcoidosis (PS) shares a number of clinical, radiological, and histopathological characteristics with that of pulmonary tuberculosis (PTB). Due to this, clinicians face issues in differentiating between PS and PTB in a substantial number of cases. There is a lack of any specific biomarker that can diagnose PS distinctively from PTB. We compared T-cell-based signature cytokines in patients with PS and PTB. In this study, we proposed a serum biomarker panel consisting of cytokines from cells: T helper (Th) 1 [interferon-gamma (IFN-γ); tumor necrosis factor-alpha (TNF-α)], Th9 [interleukin (IL)-9], Th17 [IL-17], and T regulatory (Treg) [IL-10; transforming growth factor-beta (TGF-β)]. We performed the principal component analysis that demonstrated that our serum cytokine panel has a significant predictive ability to differentiate PS from PTB. Our results could aid clinicians to improve the diagnostic workflow for patients with PS in TB endemic settings where the diagnosis between PS and PTB is often ambiguous.
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Affiliation(s)
- Rashi Jain
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rinkee Kumari
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Sushmita Chakraborty
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Dipendra K Mitra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Lu L, Wein AN, Villanueva A, Jones C, Anderson A, Ritter J, Lin CY. Clinical and Histopathologic Characteristics of Recurrent Sarcoidosis in Posttransplant Lungs: 25 Years of Experience. Am J Surg Pathol 2023; 47:1034-1038. [PMID: 37317999 DOI: 10.1097/pas.0000000000002074] [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] [Indexed: 06/16/2023]
Abstract
Lung transplantation is the definitive therapy for end-stage pulmonary sarcoidosis. While recurrent sarcoidosis in allografts has been described in several case reports, the incidence and clinicopathologic characteristics remain unclear. In this study, we characterize the clinical and histopathologic features of recurrent sarcoidosis diagnosed in posttransplant lung surveillance transbronchial biopsies (TBBx). We identified 35 patients who underwent lung transplant for pulmonary sarcoidosis during the study period. Among them, 18 patients (51%) experienced recurrent sarcoidosis posttransplant. These included 7 females and 11 males with mean age at recurrence of 51.6 years. The average time interval from transplant to recurrence was 252 days (22 to 984 d). All TBBx contained >4 pieces of alveolated lung tissue with no evidence of International Society for Heart and Lung Transplantation (ISHLT) grade A2, A3, or A4 acute cellular rejection; chronic rejection; or antibody-mediated rejection. There were 33 surveillance TBBx that contained granulomatous inflammation with a mean of 3.6 well-formed granulomas per TBBx (range: 1 to >20). Multinucleated giant cells were identified in 11 TBBx (33.3%), with 1 case containing asteroid bodies. While most of the granulomas were "naked granulomas," 5 cases (15.2%) showed prominent lymphoid cuffing. Two cases showed evidence of fibrosis. One of the granulomas had focal necrosis; however, no infectious organisms were identified by special stains and clinical correlation suggested this case represented recurrent sarcoidosis. Biopsies of recurrent sarcoidosis usually show multiple well-formed granulomas with giant cells in more than half of the cases, while lymphoid cuffing, fibrosis, asteroid bodies, and necrotizing granulomas are uncommon findings. Pathologists should be aware of these features, as recurrence of sarcoidosis following lung transplant occurs in more than half of patients.
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Affiliation(s)
- Liang Lu
- Department of Pathology and Immunology, Washington University School of Medicine
| | - Alexander N Wein
- Department of Pathology and Immunology, Washington University School of Medicine
| | - Ana Villanueva
- Department of Pathology and Immunology, Washington University School of Medicine
| | - Christopher Jones
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Adam Anderson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jon Ritter
- Department of Pathology and Immunology, Washington University School of Medicine
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University School of Medicine
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Gavrysyuk V, Merenkova I, Dziublyk Y, Gumeniuk G, Gumeniuk M. REFRACTORY PULMONARY SARCOIDOSIS: INCIDENCE AFTER TREATMENT WITH METHYLPREDNISOLONE AND/OR METHOTREXATE IN PATIENTS WITH NEWLY DIAGNOSED DISEASE. Georgian Med News 2023:143-147. [PMID: 37805888] [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: 10/09/2023]
Abstract
Pulmonary sarcoidosis is considered refractory if glucocorticoids (GCs) at a maintenance dose of at least 10 mg/day (prednisolone equivalent) and methotrexate (MTX), including their combined use, are not effective enough to achieve clinical remission. Aim - to study the rate of refractory pulmonary sarcoidosis after conventional treatment with methylprednisolone (MP) and/or MTX in patients with newly diagnosed disease. 250 patients with newly diagnosed pulmonary sarcoidosis (106 men and 144 women; mean age 44 years) were examined. Radiological stage II was established in 237 (94.8%) patients, stage III - in 13 (5.2%). GCs therapy was carried out using MP in 190 patients at an initial dose of 0.4 mg/kg/day for 4 weeks with a gradual decrease to a maintenance dose (0.1 mg/kg/day) by the end of the 6th month. In the presence of contraindications or serious adverse effects of MP (60 patients), MTX was used at a dose of 15 mg/week. Patients without contraindications and serious adverse effects of MP treated with MTX, in case of initial therapy failure, were prescribed combined therapy with MP (12 mg/day) and MTX (10 mg/week). Based on combination therapy outcomes, as well as taking into account the cases of MTX therapy failure in patients with contraindications or serious adverse effects of GCs therapy, refractory pulmonary sarcoidosis was diagnosed in 27 (10.8%) patients. Patients with refractory pulmonary sarcoidosis were more likely to have stage III disease (Pearson's χ2 test=5.766, p=0.018), as well as extrapulmonary lesions (χ2 test=4.672, p=0.031). The high rate of conventional therapy failure using first- and second-line medications in patients with newly diagnosed sarcoidosis determines the relevance of further study of the causes, development of risk criteria and new approaches to the treatment of refractory pulmonary sarcoidosis.
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Affiliation(s)
- V Gavrysyuk
- 1National Institute of Phthisiology and Pulmonology named after F. G. Yanovskiy NAMS of Ukraine, Kyiv, Ukraine
| | - I Merenkova
- 1National Institute of Phthisiology and Pulmonology named after F. G. Yanovskiy NAMS of Ukraine, Kyiv, Ukraine
| | - Y Dziublyk
- 1National Institute of Phthisiology and Pulmonology named after F. G. Yanovskiy NAMS of Ukraine, Kyiv, Ukraine
| | - G Gumeniuk
- 2National University of Health Care of Ukraine named after P. L. Shupyk, Kyiv, Ukraine
| | - M Gumeniuk
- 1National Institute of Phthisiology and Pulmonology named after F. G. Yanovskiy NAMS of Ukraine, Kyiv, Ukraine
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15
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Della Torre A, Di Francesco P, Montanelli GA, Bolis M, Comelli A, Ferrarese M, Croci GA, Tobaldini E. An unusual case of pleural effusion. Intern Emerg Med 2023; 18:1127-1131. [PMID: 36890333 DOI: 10.1007/s11739-023-03236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/17/2023] [Indexed: 03/10/2023]
Abstract
CASE PRESENTATION A 63-year-old man presented with fever, thoracalgia, weight loss, diffuse lymphadenopathy, and a massive pleural effusion. Extensive laboratory and radiologic investigations for possible autoimmune, infectious, hematologic, and neoplastic conditions all resulted negative. A lymph node biopsy showed a granulomatous necrotizing lymphadenitis, suspicious for tuberculosis. Although mycobacterium tuberculosis (MT) was never isolated and tuberculin skin test resulted negative, diagnosis of extrapulmonary tuberculosis was made and anti-tubercular therapy was started. Despite the strict adherence to 5 months of treatment, he returned to the emergency ward complaining of fever, chest pain and pleural effusion; total-body CT and PET scans demonstrated a progression of new disseminated nodular consolidations. DIAGNOSTIC WORK-UP Microscopic and cultural search for MT and other micro-organisms resulted again negative on urine, stool, blood, pleural fluid, and spinal lesion biopsy. We therefore started considering alternative diagnosis for necrotizing granulomatosis, including multidrug-resistant tuberculosis, Wegener granulomatosis, Churg Strauss syndrome, necrobiotic nodules of rheumatoid arthritis, lymphomatoid granulomatosis and Necrotizing Sarcoid Granulomatosis (NSG). Having already rejected other autoimmune, hematological, and neoplastic disorders, NSG resulted the most consistent hypothesis. With an expert we thus re-examined histological specimens that were suggestive for an atypical presentation of sarcoidosis. Steroid therapy was initiated, achieving symptoms improvement. DISCUSSION Sarcoidosis is a rare condition that can be challenging to diagnose, due to its variability in clinical presentation, often mimicking alternative conditions like disseminated tuberculosis. A high degree of suspicion and an experienced lab in anatomical pathology are essential for final diagnosis.
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Affiliation(s)
- Alice Della Torre
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Pietro Di Francesco
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Gaia Annalisa Montanelli
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Matteo Bolis
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Agnese Comelli
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Maurizio Ferrarese
- Regional TB Reference Centre, Villa Marelli Institute and Laboratory/ASST GOM Niguarda, 20122, Milan, Italy
| | - Giorgio Alberto Croci
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy.
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16
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Chen AYC, Halani S, Shah R. Dyspnoea in a patient with biopsy-proven pulmonary sarcoidosis: the challenges in diagnosing cardiac sarcoidosis. BMJ Case Rep 2023; 16:e252737. [PMID: 37217232 PMCID: PMC10230939 DOI: 10.1136/bcr-2022-252737] [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] [Indexed: 05/24/2023] Open
Abstract
A man in his 60s with biopsy-proven pulmonary sarcoidosis, not on treatment, presented with 6 weeks of dyspnea to the emergency department. ECG showed first-degree atrioventricular block and CT thorax demonstrated progressive pulmonary sarcoidosis with new multifocal consolidation. Antibiotics were initiated.A brain natriuretic peptide was elevated at 2024 ng/L and echocardiogram showed global left ventricular systolic dysfunction. Coronary angiogram revealed normal coronary arteries, and cardiac positron emission tomography and MRI demonstrated patterns compatible with cardiac sarcoidosis. The patient significantly improved with diuresis; he was started on prednisone, methotrexate and standard heart failure therapies.We outline the difficulties of attributing cardiac causes of dyspnoea in a patient with known pulmonary sarcoidosis given the rarity of cardiac involvement. We review proposed diagnostic criteria for cardiac sarcoidosis using enhanced imaging techniques without requiring invasive myocardial biopsy. This case discussion also highlights nuances in managing cardiac sarcoidosis based on the best available evidence and expert consensus.
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Affiliation(s)
| | - Sheliza Halani
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rupal Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- General Internal Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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17
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Drake WP, Hsia C, Samavati L, Yu M, Cardenas J, Gianella FG, Boscardin J, Koth LL. Risk Indicators of Sarcoidosis Evolution-Unified Protocol (RISE-UP): protocol for a multi-centre, longitudinal, observational study to identify clinical features that are predictive of sarcoidosis progression. BMJ Open 2023; 13:e071607. [PMID: 37012011 PMCID: PMC10083794 DOI: 10.1136/bmjopen-2023-071607] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Sarcoidosis is a pulmonary and systemic granulomatous disease with a wide range of potential outcomes, from spontaneous resolution to end-stage organ damage and death. Currently, clinicians have no easy-to-use risk stratification tools for important clinical outcomes in sarcoidosis, such as progressive lung disease. This study will address two clinical practice needs: (1) development of a risk calculator that provides an estimate of the likelihood of pulmonary progression in sarcoidosis patients during the follow-up period and (2) determine the optimal interval for serial clinical monitoring (eg, 6, 12, 18 months) using these risk prediction tools. METHODS AND ANALYSIS The Risk Indicators of Sarcoidosis Evolution-Unified Protocol study is a National Institutes of Health-sponsored, longitudinal observational study of adults with pulmonary sarcoidosis who will be enrolled at five US tertiary care centres. Participants will be evaluated at approximately 6-month intervals for up to 60 months with collection of lung function, blood samples and clinical data. The target sample size is 557 and the primary objective is to determine which clinical features measured during a routine clinic visit carry the most prognostic information for predicting clinical progression of pulmonary sarcoidosis over the follow-up period. The primary outcome measure will be quantified by a clinically meaningful change in forced vital capacity, forced expiratory volume in 1 s or diffusing capacity of the lung for carbon monoxide. The secondary objective is to determine if blood biomarkers measured during a routine clinic visit can improve the risk assessment modelling for progression of pulmonary sarcoidosis over the follow-up period. ETHICS AND DISSEMINATION The study protocol has been approved by the Institutional Review Boards at each centre and the reliance Institutional Review Board overseeing the study (WCG, Protocol #20222400). Participants will provide informed consent prior to enrolment. Results will be disseminated via publication in a relevant peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05567133.
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Affiliation(s)
- Wonder P Drake
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Connie Hsia
- Department of Internal Medicine, UT Southwestern Medical School, Dallas, Texas, USA
| | - Lobelia Samavati
- Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michelle Yu
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica Cardenas
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Fabiola G Gianella
- Department of Internal Medicine, UT Southwestern Medical School, Dallas, Texas, USA
| | - John Boscardin
- Department of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Laura L Koth
- Department of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
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18
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Judson MA, Spagnolo P, Stanfel R, Farrow G, Tanase AM, Perna F, Baughman RP. Living with sarcoidosis: Virtual roundtable dialogue with patients and healthcare professionals. Respir Med 2023; 210:107174. [PMID: 36871867 DOI: 10.1016/j.rmed.2023.107174] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Sarcoidosis is a multisystem disease, characterised by the infiltration of various organs by non-necrotising granulomas. The disease's heterogeneity complicates the study of patients' experiences. OBJECTIVE To gather insight into life experiences, unmet needs and views on hypothetically emerging treatment options among patients living with sarcoidosis. METHODS Multinational, virtual, interactive, moderated discussion of specific questions between people with sarcoidosis, with experienced clinicians participating. RESULTS Nine patients with sarcoidosis from Australia, Denmark, Germany, Italy, Japan and the US, and three clinicians took part. All patients had pulmonary sarcoidosis, self-assessed as mild by five patients. The path to diagnosis was convoluted, with up to four physicians and a large number of tests involved. There was agreement that the process would be improved by earlier referral to specialists. The patients made a clear distinction between 'living with a condition' (adapting to the disease) and 'being ill'. The concept of remission was viewed sceptically as disease might develop in multiple organs. Panellists had a pragmatic attitude to therapies: side effects during a treatment course were accepted if overall symptoms improved. When considering hypothetical new therapies, improved quality of life (QoL) was the most important need; improved tolerability had lower priority. New therapies should be targeted on reducing disease progression and improving symptoms and QoL rather than corticosteroid withdrawal. CONCLUSIONS The interactive exchange provided insights into the need for earlier specialist referrals, distrust of the concept of remission in sarcoidosis, and the need for therapies targeted on reducing disease progression and improving symptoms and QoL.
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Affiliation(s)
| | - Paolo Spagnolo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health. University of Padova, Padova, Italy
| | | | - Garrie Farrow
- Foundation for Sarcoidosis Research, Chicago, IL, USA
| | | | | | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, 200 Albert Sabin Way, Room 1001, Cincinnati, OH, 45267, USA.
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19
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Sharp M, Psoter KJ, Balasubramanian A, Pulapaka AV, Chen ES, Brown SAW, Mathai SC, Gilotra NA, Chrispin J, Bascom R, Bernstein R, Eakin MN, Wise RA, Moller DR, McCormack MC. Heterogeneity of Lung Function Phenotypes in Sarcoidosis: Role of Race and Sex Differences. Ann Am Thorac Soc 2023; 20:30-37. [PMID: 35926103 PMCID: PMC9819274 DOI: 10.1513/annalsats.202204-328oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [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: 04/14/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
Rationale: Historically, sarcoidosis was described as a restrictive lung disease, but several alternative phenotypes of pulmonary function have been observed. Pulmonary function phenotypes in sarcoidosis may represent different clinical and/or molecular phenotypes. Objectives: To characterize the prevalence of different pulmonary function phenotypes in a large and diverse sarcoidosis cohort from a tertiary care referral center. Methods: We identified individuals seen between 2005-2015 with a confirmed diagnosis of sarcoidosis. Data were collected from the first pulmonary function test (PFT) performed at our institution which included spirometry and diffusing capacity of the lung for carbon monoxide (DlCO). Demographics and clinical data were collected. Chi-squared analyses and multiple linear regressions were done to assess statistical differences and associations. Global Lung Function Initiative equations were used to calculate percent predicted measurements for spirometry and DlCO. Results: Of 602 individuals with sarcoidosis, 93% (562) had pulmonary involvement, 64% (385) were female, and 57% (341) were Black. Of those with pulmonary involvement, 56% had abnormal pulmonary function. Lung function impairment phenotypes included: 47% restriction, 22% obstruction, 15% isolated reduction in DlCO, and 16% combined obstructive restrictive phenotype. Restriction was the most common PFT phenotype among Black individuals (41%), while no lung impairment was most common among White individuals (66%) (P < 0.001). Males more frequently had obstruction (19%) compared with females (9%) P = 0.001, and females had more restriction (30%) compared with males (21%) P = 0.031. Conclusions: Among individuals with sarcoidosis and pulmonary function impairment, less than half demonstrated a restrictive phenotype. There were significant differences in pulmonary function phenotypes by race and sex.
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Affiliation(s)
- Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Kevin J. Psoter
- Division of General Pediatrics, Department of Pediatrics, and
| | | | - Anuhya V. Pulapaka
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Edward S. Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, John Hopkins School of Medicine, Baltimore, Maryland; and
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, John Hopkins School of Medicine, Baltimore, Maryland; and
| | - Rebecca Bascom
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard Bernstein
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Robert A. Wise
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - David R. Moller
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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20
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Abstract
Sarcoidosis is an immune-mediated disorder. Its immunopathology has been steadily mapped out over the past few decades. Despite this, the underpinning mechanisms for progressive fibrotic sarcoidosis is an almost uncharted area. Consequently, there has been little change in the clinical management of fibrotic sarcoidosis over the decades and an unfocused search for new therapeutics. In this review, we provide a comprehensive examination of the relevant immune findings in fibrotic and/or progressive pulmonary sarcoidosis and propose a unifying mechanism for the pathobiology of fibrosis in sarcoidosis.
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Affiliation(s)
- Praveen Weeratunga
- Oxford Sarcoidosis Clinic, Oxford Interstitial Lung Disease Service, Oxford, UK
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - David R Moller
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ling-Pei Ho
- Oxford Sarcoidosis Clinic, Oxford Interstitial Lung Disease Service, Oxford, UK
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
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21
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Abstract
PURPOSE We retrospectively analyzed the frequency and clinical characteristics of organs rarely involved with sarcoidosis in a cohort of 1158 sarcoidosis patients cared for over nearly 11 years in a university outpatient sarcoidosis clinic. METHODS Data were analyzed from an institution-approved sarcoidosis clinical database containing demographic and clinical characteristics of sarcoidosis outpatients cared for between May 2011 and March 2021 at a university medical center sarcoidosis clinic. The diagnosis of sarcoidosis was established by standard international criteria. Rare organ involvement was defined as an organ not individually listed in the Word Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Organ Assessment Instrument. RESULTS Twenty-six of the 1158 patients (2.2%) had 27 instances of rare organ involvement. The most common rare organ involved was the GI tract, followed by the testicle and then the female reproductive tract. Only 1 of the 26 patients with rare sarcoidosis organ involvement required therapy for that organ involvement. In comparison with sarcoidosis patients without rare organ involvement, patients with rare organ involvement were more likely to be black, have more total organs involved with sarcoidosis, and more likely require anti-sarcoidosis therapy at some point during the course of their disease. There were no differences between these groups in terms of sex, age at diagnosis, and most recent percent predicted forced vital capacity. CONCLUSIONS Rare sarcoidosis organ involvement occurred in 2.2 percent of this cohort. Although rare organ involvement rarely required treatment, it was associated with more extensive disease that was more likely to require therapy.
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Affiliation(s)
- Isam Albaba
- Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - M Fish Kenneth
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.
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22
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Belperio JA, Weigt SS, Lynch JP. A Review of the Diagnosis and Treatment of Pulmonary Sarcoidosis-Reply. JAMA 2022; 328:78. [PMID: 35788797 DOI: 10.1001/jama.2022.7774] [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: 11/14/2022]
Affiliation(s)
- John A Belperio
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, University of California David Geffen School of Medicine, Los Angeles
| | - S Samuel Weigt
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, University of California David Geffen School of Medicine, Los Angeles
| | - Joseph P Lynch
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, University of California David Geffen School of Medicine, Los Angeles
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23
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Ben Salem C. A Review of the Diagnosis and Treatment of Pulmonary Sarcoidosis. JAMA 2022; 328:77-78. [PMID: 35788801 DOI: 10.1001/jama.2022.7765] [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: 11/14/2022]
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24
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Kašiković Lečić S, Lovrenski A, Đokić J, Popović M, Javorac J, Milenković A, Živanović D. Does miliary sarcoidosis really exist? A case report and review of the literature. Eur Rev Med Pharmacol Sci 2022; 26:5098-5102. [PMID: 35916806 DOI: 10.26355/eurrev_202207_29296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Miliary sarcoidosis is a rare form of sarcoidosis characterized by numerous miliary-like micronodules dispersed throughout the lungs. It has been documented in less than 1% of all sarcoidosis cases. We first described a rare case of miliary sarcoidosis and then conducted a literature review on the subject. CASE PRESENTATION A 51-year-old male complained about a progressive loss of appetite, significant weight loss, occasional night sweats, and fatigue. After a thorough clinical exploration, a differential diagnosis of miliary lung disease was suspected - miliary tuberculosis, fungal infection, metastatic pulmonary carcinoma, or sarcoidosis. High-resolution chest computed tomography revealed bilateral diffuse micronodules with mediastinal lymphadenopathy. Histopathological analysis of transbronchial bioptic tissue identified non-caseating epithelioid granulomas, while no malignant cells were found. Lung tuberculosis and fungal infections were excluded. The levels of angiotensin-converting enzyme in the blood, as well as serum's and 24-hour urine calcium levels, were elevated. After a multidisciplinary discussion, the diagnosis of miliary pulmonary sarcoidosis was established. The patient was treated with prednisone for a total of 9 months, with full clinical and radiological recovery. Using PubMed, we also conducted a review of the literature on this topic and discovered only a few case reports of patients with miliary sarcoidosis, with just one systematic review accessible. The key findings of studies investigating patients diagnosed with miliary sarcoidosis are tabularly displayed. CONCLUSIONS Miliary sarcoidosis is an uncommon type of pulmonary sarcoidosis that can mimic several entities that manifest as miliary nodules. Most patients require treatment since it can have a significant impact on lung function.
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Affiliation(s)
- S Kašiković Lečić
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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25
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Valappil A, Sundar S S, Johny M, Ahamed Tp J. Intracranial necrotising sarcoid granulomatosis mimicking petroclival meningioma. BMJ Case Rep 2022; 15:e247792. [PMID: 35580943 PMCID: PMC9114961 DOI: 10.1136/bcr-2021-247792] [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] [Accepted: 04/28/2022] [Indexed: 11/03/2022] Open
Abstract
We present a unique case of biopsy-proven necrotising sarcoidosis involving the central nervous system in a man in his 40s. The patient presented with a 2-week history of right-sided headache and diplopia. He had right trochlear and abducens nerve palsy, sensory blunting over V1 and V2 segment of right trigeminal sensory nerve and right sensory neural hearing loss. A contrast-enhanced MRI revealed an enhancing dural-based mass lesion in the petroclival area suggestive of probable meningioma. Surgical resection was attempted and intraoperative consultation with frozen section revealed granulomata. So, the lesion was biopsied and surgical intervention was terminated. A diagnosis of necrotising neurosarcoidosis was confirmed on histopathology. He was treated with steroids after excluding other causes of intracranial necrotising granulomas like tuberculosis and he clinically responded favourably. We report one of the very few case reports of histologically proven necrotising sarcoidosis involving the central nervous system mimicking petroclival meningioma.
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Abstract
IMPORTANCE Sarcoidosis is an inflammatory granulomatous disease of unknown cause that affects an estimated 2 to 160 people per 100 000 worldwide and can involve virtually any organ. Approximately 10% to 30% of patients with sarcoidosis develop progressive pulmonary disease. OBSERVATION Among patients with pulmonary sarcoidosis, the rate of spontaneous remission without serious sequelae ranges from 10% to 82%. However, lung disease progression occurs in more than 10% of patients and can result in fibrocystic architectural distortion of the lung, which is associated with a mortality rate of 12% to 18% within 5 years. Overall, the mortality rate for sarcoidosis is approximately 7% within a 5-year follow-up period. Worldwide, more than 60% of deaths from sarcoidosis are due to pulmonary involvement; however, more than 70% of deaths from sarcoidosis are due to cardiac involvement in Japan. Up to 70% of patients with advanced pulmonary sarcoidosis develop precapillary pulmonary hypertension, which is associated with a 5-year mortality rate of approximately 40%. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues. Although optimal doses of oral glucocorticoids for pulmonary sarcoidosis are unknown, oral prednisone typically starting at a dose of 20 mg/d to 40 mg/d for 2 to 6 weeks is recommended for patients who are symptomatic (cough, dyspnea, and chest pain) and have parenchymal infiltrates and abnormal pulmonary function test results. Oral glucocorticoids can be tapered over 6 to 18 months if symptoms, pulmonary function test results, and radiographs improve. Prolonged use of oral glucocorticoids may be required to control symptoms and stabilize disease. Patients without adequate improvement while receiving a dose of prednisone of 10 mg/d or greater or those with adverse effects due to glucocorticoids may be prescribed immunosuppressive agents, such as methotrexate, azathioprine, or an anti-tumor necrosis factor medication, either alone or with glucocorticoids combined with appropriate microbial prophylaxis for Pneumocystis jiroveci and herpes zoster. Effective treatments are not available for advanced fibrocystic pulmonary disease. CONCLUSIONS AND RELEVANCE Sarcoidosis has a mortality rate of approximately 7% within a 5-year follow-up period. More than 10% of patients with pulmonary sarcoidosis develop progressive disease and more than 60% of deaths are due to advanced pulmonary sarcoidosis. Oral glucocorticoids with or without another immunosuppressive agent are the first-line therapy for symptomatic patients with abnormal pulmonary function test results and lung infiltrates. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues.
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Affiliation(s)
- John A Belperio
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California, Los Angeles
| | - Faisal Shaikh
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California, Los Angeles
| | - Fereidoun G Abtin
- Thoracic and Interventional Section, Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - S Samuel Weigt
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California, Los Angeles
| | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California, Los Angeles
| | - Joseph P Lynch
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California, Los Angeles
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27
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Kim JH, Nam BD, Hwang JH, Kim DW, Kim KU, Park YW. Necrotizing sarcoid granulomatosis simulating pulmonary malignancy: A case report. Medicine (Baltimore) 2021; 100:e28208. [PMID: 34889304 PMCID: PMC8663815 DOI: 10.1097/md.0000000000028208] [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] [Received: 10/25/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Necrotizing sarcoid granulomatosis (NSG) has recently been termed "sarcoidosis with NSG pattern" for the disease entity representing nodular sarcoidosis with granulomatous pulmonary angiitis. It is characterized by sarcoid-like granulomas, vasculitis, and a variable degree of necrosis. Its rarity and nonspecific clinical symptoms can easily lead to misdiagnosis or delayed diagnosis. PATIENT CONCERNS We report a 67-year-old female with a biopsy-confirmed sarcoidosis with NSG pattern mimicking pulmonary malignancy on initial chest computed tomography scan. DIAGNOSES Sarcoidosis with NSG pattern. INTERVENTIONS The patient underwent video-assisted thoracoscopic surgery with a lung biopsy. No further treatment was performed after the lung biopsy. OUTCOMES Follow-up imaging studies revealed spontaneous regression of the disease after 2 months. LESSONS Awareness of this rare benign disease entity and overlapping radiologic manifestations with pulmonary malignancy or other granulomatous diseases can be helpful for making a precise diagnosis with a better differential diagnosis.
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Affiliation(s)
- Jun Hyeok Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Dong Won Kim
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Ki-Up Kim
- Department of Allergy and Respiratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Young Woo Park
- Department of Cardiothoracic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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28
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Rutkowska E, Kwiecień I, Bednarek J, Sokołowski R, Raniszewska A, Jahnz-Różyk K, Rzepecki P. T Lymphocyte Maturation Profile in the EBUS-TBNA Lymph Node Depending on the DLCO Parameter in Patients with Pulmonary Sarcoidosis. Cells 2021; 10:cells10123404. [PMID: 34943912 PMCID: PMC8699538 DOI: 10.3390/cells10123404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/13/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022] Open
Abstract
Sarcoidosis (SA) is a systemic granulomatous disorder of unknown etiology with lung and mediastinal lymph nodes (LNs) as the main location. T lymphocytes play important role in the formation of granulomas in SA, but still little is known about the role of maturation profile in the development of inflammatory changes. The aim of this study was to determine the CD4+ and CD8+ T cells maturation profile in LNs and in peripheral blood (PB) and its relation to disease severity expressed by diffusing capacity of the lung for carbon monoxide (DLCO). 29 patients with newly pulmonary SA were studied. Flow cytometry was used for cells evaluation in EBUS-TBNA samples. We observed lower median proportion of T lymphocytes, CD4+ T and CD8+ T cells in patients with DLCO< 80% than in patients with normal diffusion (DLCO > 80%). Patients with DLCO < 80% had lower median proportion of effector and higher median proportion of central memory CD4+ and CD8+ T cells than patients with DLCO > 80%. We reported for the first time that LNs CD4+ and CD8+ T cells maturation differs depending on the DLCO value in sarcoidosis. Lymphocytes profiles in LNs may reflect the immune status of patients with SA and can be analysed by flow cytometry of EBUS-TBNA samples.
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Affiliation(s)
- Elżbieta Rutkowska
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, 04-141 Warsaw, Poland; (I.K.); (A.R.)
- Correspondence: ; Tel.: +48-880-113-513
| | - Iwona Kwiecień
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, 04-141 Warsaw, Poland; (I.K.); (A.R.)
| | - Joanna Bednarek
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.B.); (R.S.); (K.J.-R.)
| | - Rafał Sokołowski
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.B.); (R.S.); (K.J.-R.)
| | - Agata Raniszewska
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, 04-141 Warsaw, Poland; (I.K.); (A.R.)
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.B.); (R.S.); (K.J.-R.)
| | - Piotr Rzepecki
- Department of Internal Medicine and Hematology, Military Institute of Medicine, 04-141 Warsaw, Poland;
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29
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Murakami K, Hata S, Ishibashi N, Kubota M, Eishi Y, Uchida K, Tabata T, Nakamura Y, Murakami K. A Solitary Necrotizing Sarcoid Granulomatosis-like Pulmonary Lesion Possibly Associated with Propionibacterium acnes and Mycobacterium avium. Intern Med 2021; 60:3773-3778. [PMID: 34121004 PMCID: PMC8710391 DOI: 10.2169/internalmedicine.7162-21] [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: 11/24/2022] Open
Abstract
We report a case of a pulmonary necrotizing sarcoid granulomatosis (NSG)-like lesion possibly associated with coinfection of Mycobacterium avium and Propionibacterium acnes. A solitary nodule in the right middle lobe of the lung was notable for coagulative necrosis with aggregates of sarcoid-like epithelioid granulomas. Small arteries were damaged by granulomas. Both M. avium and P. acnes were detected in the lesion. Furthermore, more P. acnes genomes were detected in the granulomas than in the non-lesion lung. These findings blur the pathophysiologic boundaries among NSG, sarcoidosis, and mycobacteriosis, and suggest that NSG needs to be recognized as continuous spectra of sarcoidosis/mycobcteriosis.
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Affiliation(s)
- Keigo Murakami
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Shuko Hata
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Naoya Ishibashi
- Division of Thoracic Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Motoki Kubota
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Japan
| | - Keisuke Uchida
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Japan
| | - Toshiharu Tabata
- Division of Thoracic Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuhiro Murakami
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
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Abstract
ABSTRACT Pulmonary sarcoidosis is a multisystem disease characterized by sarcoid granulomas, vasculitis, and degrees of necrosis with unknown etiology. This article discusses the pathophysiology of sarcoidosis and its medical and nursing management. A case presentation highlights some long-term concerns with this chronic disease.
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Affiliation(s)
- Anna Crawford
- Anna Crawford is a nursing student at York College. Lisa A. Ruth-Sahd is a professor of nursing at York College in York, Pa., and an adjunct professor at Georgetown University in Washington, D.C. She is a fellow in the American Academy of Nurse Educators
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31
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Affiliation(s)
- Margaret M Chapman
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
| | - Victorine V Muse
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
| | - James E Mojica
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
| | - Melis N Anahtar
- From the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (M.M.C., J.E.M.), Radiology (V.V.M.), and Pathology (M.N.A.), Harvard Medical School - both in Boston
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32
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Hon SA, Lee LT, Tan KK, Lee RA, Low QJ. Hepatic Sarcoidosis: Diagnostic approach and management. Med J Malaysia 2021; 76:914-917. [PMID: 34806684] [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: 06/13/2023]
Abstract
Sarcoidosis is a multi-systemic, non-caseating granulomatous disorder with an idiopathic aetiology. We report a 58-year-old Malay woman, with underlying type II diabetes mellitus, hypertension and history of stage II pulmonary sarcoidosis presenting with incidental finding of multiple hypodense liver lesions. Her recent contrasted enhanced computed tomography of the abdomen and pelvis demonstrated multiple intra-abdominal lymphadenopathies with evidence of liver and splenic infiltrations. Her ageappropriate malignancy screening was negative while liver biopsy showed non-caseating granulomatous hepatitis consistent with hepatic sarcoidosis. In view of her normal liver enzymes and normalised serum calcium levels, no immunosuppressive therapy was commenced. She remains asymptomatic and is currently under our close monitoring.
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Affiliation(s)
- S A Hon
- Hospital Sultanah Nora Ismail, Department of Internal Medicine, Batu Pahat, Johor, Malaysia.
| | - L T Lee
- Hospital Sultanah Aminah, Department of Surgery, Johor Bahru, Johor, Malaysia
| | - K K Tan
- Hospital Pakar Sultanah Fatimah, Department of Pathology, Muar, Johor, Malaysia
| | - R A Lee
- Hospital Sultanah Nora Ismail, Department of Radiology, Batu Pahat, Johor, Malaysia
| | - Q J Low
- Hospital Sultanah Nora Ismail, Department of Internal Medicine, Batu Pahat, Johor, Malaysia
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33
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Patel L, Elavarasi A, Garg A, Nambirajan A. Cerebellar progressive multifocal leukoencephalopathy associated with pulmonary sarcoidosis. BMJ Case Rep 2021; 14:e245271. [PMID: 34580133 PMCID: PMC8477238 DOI: 10.1136/bcr-2021-245271] [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] [Accepted: 09/12/2021] [Indexed: 11/04/2022] Open
Abstract
Progressive multifocal leukoencephalopathy can complicate the course of a patient with sarcoidosis. Here we present a rare case of a 35-year-old patient with pulmonary sarcoidosis whose course was complicated by progressive multifocal leukoencephalopathy involving the cerebellum. Neuroimaging and cerebrospinal fluid PCR played a crucial role in the diagnosis.
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Affiliation(s)
- Lajjaben Patel
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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34
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El Jazouly M, Chahboun F, Kelati A, El Omari M, Al Bouzidi A, Chiheb S. [Scar sarcoidosis: a usually progressive disease (about a case)]. Pan Afr Med J 2021; 39:268. [PMID: 34707769 PMCID: PMC8520421 DOI: 10.11604/pamj.2021.39.268.27864] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Abstract
The sarcoidosis is a systemic granulomatous disease. It is usually characterized by skin manifestations which may be suggestive of progressive sarcoidosis with visceral involvement. We here report a case of pulmonary sarcoidosis revealed by the reactivation of an old cutaneous scar following a trauma occurred 20 years earlier. Radiological assessment showed mediastino-pulmonary sarcoidosis stage 2. The diagnosis of sarcoidosis should be suspected in patients with any recent scar modification in order to establish early management.
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Affiliation(s)
- Madiha El Jazouly
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Fatimzahra Chahboun
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Awatef Kelati
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Mounia El Omari
- Service de Chirurgie Plastique, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Abderahman Al Bouzidi
- Service d´Anatomopathologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Soumiya Chiheb
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
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35
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Abo Al Hayja M, Wahlström J, Kullberg S, Darlington P, Eklund A, Grunewald J. Bronchoalveolar lavage fluid cell subsets associate with the disease course in Löfgren's and non-Löfgren's sarcoidosis patients. Respir Med 2021; 186:106521. [PMID: 34198166 DOI: 10.1016/j.rmed.2021.106521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sarcoidosis is a multisystem granulomatous inflammatory disorder, that predominantly involves the lungs. Patients with Löfgren's syndrome (LS) are characterized by acute onset and usually have the HLA-DRB1*03 (DR3positive) allele and a good prognosis. Non-LS patients are usually DR3negative and are more likely to develop chronic disease. The study aimed to identify bronchoalveolar lavage fluid (BALF) cells that could associate with disease severity (reduced pulmonary function tests (PFTs), advanced chest radiographs, need for treatment) and/or chronicity (duration >2 years) in newly diagnosed LS and non-LS patients, respectively. METHODS We retrospectively included data from 955 non-LS patients, 477 LS patients, and 295 healthy controls (HC) in this study. Intra-group comparison of patients with resolving versus chronic disease was performed in LS and non-LS, respectively. Non-LS patients were divided into two subgroups according to the binary BALF cell concentrations for intra-group comparison (i.e. higher or lower than the 95th percentile of the BALF cells references in healthy individuals). RESULTS LS patients with a non-resolving disease course had higher BALF lymphocytes, neutrophils, and eosinophils than LS with a favourable outcome. In non-LS subjects increased BALF of the same cells and in addition also of basophils and mast cells were more likely associated with more severe disease course. CONCLUSION Increased BALF cells display prognostic significance in sarcoidosis. Certain BALF profiles should promote the clinician to monitor these patients more closely as they may associate non-resolving disease, in turn, resulting in future irreversible functional impairment.
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Affiliation(s)
- Muntasir Abo Al Hayja
- Respiratory Medicine Division, Department of Medicine, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - Jan Wahlström
- Respiratory Medicine Division, Department of Medicine, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Susanna Kullberg
- Respiratory Medicine Division, Department of Medicine, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Pernilla Darlington
- Respiratory Medicine Division, Department of Clinical Science and Education, Södersjukhuset and Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Respiratory Medicine Division, Department of Medicine, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Johan Grunewald
- Respiratory Medicine Division, Department of Medicine, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden; Respiratory Medicine Division, Department of Medicine Solna, And Center for Molecular Medicine (CMM), Karolinska Institutet; and Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
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36
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Dongre A, Dongre T, Deshmukh M, Agrawal S, Kanchankar N. Pulmonary sarcoidosis masquerading as metastatic breast cancer: a case report. Pan Afr Med J 2021; 38:245. [PMID: 34104293 PMCID: PMC8164421 DOI: 10.11604/pamj.2021.38.245.28421] [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] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022] Open
Abstract
Pulmonary lesions on imaging are presumed to be metastatic lesions in patients with breast cancer. Here, we report an interesting case of a 63-year-old lady with breast carcinoma showing pulmonary lesions on imaging suggestive of pulmonary metastases. Detailed evaluation of pulmonary lesions confirmed the presence of co-existing pulmonary sarcoidosis. Modern diagnostic methods like 18-flurodeoxyglucose positron emission tomography (18-FDG PET) are unable to clearly differentiate metastatic disease from granulomatous diseases like sarcoidosis. Thus, histological confirmation is needed for accurate staging and determining response to treatment and rarely, in non-responders, detecting any co-existing disease. This case emphasizes the need for detailed histopathological examination of lymph nodes in patients with non-responsive disease or recurrent disease despite adequate chemotherapy.
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Affiliation(s)
- Amol Dongre
- Department of Medical Oncology, Alexis Multispecialty Hospital, Nagpur, Maharashtra, India
| | - Trupti Dongre
- Department of Pathology, Narendra Kumar Prasadrao (NKP) Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
| | - Mahesh Deshmukh
- Department of Pathology, Alexis Multispecialty Hospital, Nagpur, Maharashtra, India
| | - Suraj Agrawal
- Department of Surgical Oncology, Alexis Multispecialty Hospital, Nagpur, Maharashtra, India
| | - Niraj Kanchankar
- Department of Radiology, Alexis Multispecialty Hospital, Nagpur, Maharashtra, India
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37
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Garland S, Falk N, Wilk A. Less Common Respiratory Conditions: Sarcoidosis. FP Essent 2021; 502:18-22. [PMID: 33683850] [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: 06/12/2023]
Abstract
Sarcoidosis is a systemic condition characterized by formation of granulomas that can involve many organ systems, with the lungs and intrathoracic lymph nodes involved in more than 90% of cases. Sarcoidosis also can involve the cardiac, ocular, hepatic, dermatologic, and central nervous systems. The presentation of pulmonary sarcoidosis is nonspecific. Less than half of patients initially have respiratory symptoms and the disease often is detected as an incidental finding of lymphadenopathy on chest x-ray. However, lymphadenopathy can occur in many other conditions, ranging from tuberculosis to cancer, so sarcoidosis should be diagnosed only after excluding these other conditions. Typical granulomatous findings on lymph node biopsy can increase confidence in sarcoidosis diagnosis after the other conditions are excluded. However, there are three syndromes which, if present, are diagnostic of sarcoidosis: Lofgren syndrome, Heerfordt syndrome, and lupus pernio. The majority of sarcoidosis cases resolve spontaneously, so treatment typically is reserved for patients with progressive pulmonary or extrapulmonary involvement, specifically ocular, cardiac, or central nervous system. Systemic corticosteroids are first-line treatment. Second-line treatment with methotrexate or hydroxychloroquine is used if steroids are ineffective or to enable steroid tapering. Refractory disease should be comanaged with a sarcoidosis subspecialist.
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Affiliation(s)
- Scott Garland
- Florida State University College of Medicine Family Medicine Residency Program at BayCare Health System, 1201 1st St S Suite 100A, Winter Haven, FL 33880
| | - Nathan Falk
- Florida State University College of Medicine Family Medicine Residency Program at BayCare Health System, 1201 1st St S Suite 100A, Winter Haven, FL 33880
| | - Ashley Wilk
- Florida State University College of Medicine Family Medicine Residency Program at BayCare Health System, 1201 1st St S Suite 100A, Winter Haven, FL 33880
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Sawahata M, Shijubo N, Johkoh T, Kawanobe T, Fujiki Y, Bando M, Hagiwara K, Takemura T, Konno S, Yamaguchi T. Progression of Central-peripheral Band and Traction Bronchiectasis Clusters Leading to Chronic Respiratory Failure in a Patient with Fibrotic Pulmonary Sarcoidosis. Intern Med 2021; 60:111-116. [PMID: 32830175 PMCID: PMC7835452 DOI: 10.2169/internalmedicine.4862-20] [Citation(s) in RCA: 3] [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: 11/29/2022] Open
Abstract
We herein report a rare case of pulmonary sarcoidosis leading to chronic respiratory failure with restrictive ventilatory impairment during a 53-year-long observation period. Nine years after the histological diagnosis of stage I sarcoidosis on chest X-ray in a woman in her 20s, she developed bilateral reticular and granular opacities on chest computed tomography and was started on prednisone for 18 years. Seven years after prednisone withdrawal, these persisting opacities around the bronchovascular bundle, including a central-peripheral band, had progressed, forming traction bronchiectasis clusters and peripheral cysts, some of which developed continuously at the distal side of these clusters, with eventual upper lobe shrinkage.
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Affiliation(s)
- Michiru Sawahata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | | | | | - Takeshi Kawanobe
- Department of Respiratory Medicine, JR Tokyo General Hospital, Japan
| | - Yasumaro Fujiki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Isshiki T, Matsuyama H, Yamaguchi T, Morita T, Ono J, Nunomura S, Izuhara K, Sakamoto S, Homma S, Kishi K. Plasma matrix metalloproteinase 7, CC-chemokine ligand 18, and periostin as markers for pulmonary sarcoidosis. Respir Investig 2020; 58:479-487. [PMID: 32868264 DOI: 10.1016/j.resinv.2020.07.003] [Citation(s) in RCA: 3] [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: 05/20/2020] [Revised: 07/03/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Some patients with sarcoidosis experience worsening of pulmonary lesions. However, no biomarker has been identified that reflects pulmonary disease status in sarcoidosis. We investigated the usefulness of potential markers of pulmonary fibrosis in patients with sarcoidosis. METHODS Plasma matrix metalloproteinase 7 (MMP-7), CC-chemokine ligand 18 (CCL-18), and periostin levels were evaluated in 60 patients with sarcoidosis and 30 healthy controls; bronchoalveolar lavage fluid levels were analyzed in 22 patients with sarcoidosis. To determine the usefulness of these markers, we explored potential correlations between these markers and sarcoidosis clinical characteristics. RESULTS Plasma MMP-7, CCL-18, and periostin concentrations were significantly higher in patients with sarcoidosis than those in healthy controls. MMP-7 concentrations in plasma and bronchoalveolar lavage fluid were higher in patients with sarcoidosis with parenchymal infiltration than in those without lung lesions. Moreover, MMP-7 concentration was negatively correlated with pulmonary function. CONCLUSION Among these novel biomarkers, MMP-7 most precisely reflected pulmonary sarcoidosis disease status and thus, might be useful for diagnosing and evaluating sarcoidosis, particularly in patients with pulmonary parenchymal lesions.
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Affiliation(s)
- Takuma Isshiki
- Department of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan.
| | - Hisayo Matsuyama
- Department of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan.
| | | | - Toshisuke Morita
- Department of Laboratory Medicine, Toho University School of Medicine, Tokyo, Japan.
| | | | - Satoshi Nunomura
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan.
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan.
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan.
| | - Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Disease Research, School of Medicine, Toho University, Tokyo, Japan.
| | - Kazuma Kishi
- Department of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan.
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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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Taniguchi J, Nakashima K, Ito H, Tanaka Y, Otsuki A, Shiroshita A, Yoshimi M, Kubota N, Aoshima M. Pulmonary Sarcoidosis Presenting with Acute Respiratory Failure: A Report of a Case Diagnosed by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration on Ventilation after Intubation. Intern Med 2020; 59:2291-2295. [PMID: 32536645 PMCID: PMC7578599 DOI: 10.2169/internalmedicine.4624-20] [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: 11/22/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology and is pathologically characterized by non-caseating granulomas in the organs involved. We herein report a case of sarcoidosis in a Japanese woman with acute respiratory failure, diagnosed using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) on the ventilator after intubation. Only a few cases of previously undiagnosed sarcoidosis presenting acute respiratory failure have been reported. It is important to be aware that undiagnosed sarcoidosis may present with acute respiratory failure. Therefore, EBUS-TBNA under mechanical ventilation may be useful for the immediate diagnosis of patients.
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Affiliation(s)
| | - Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Japan
| | - Hiroyuki Ito
- Department of Pulmonology, Kameda Medical Center, Japan
| | - Yu Tanaka
- Department of Pulmonology, Kameda Medical Center, Japan
| | - Ayumu Otsuki
- Department of Pulmonology, Kameda Medical Center, Japan
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Morgenthau AS, Levin MA, Freeman R, Reich DL, Klang E. Moderate or Severe Impairment in Pulmonary Function is Associated with Mortality in Sarcoidosis Patients Infected with SARS‑CoV‑2. Lung 2020; 198:771-775. [PMID: 32915271 PMCID: PMC7484928 DOI: 10.1007/s00408-020-00392-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/27/2020] [Indexed: 12/22/2022]
Abstract
Purpose To investigate whether sarcoidosis patients infected with SARS-CoV-2 are at risk for adverse disease outcomes. Study Design and Methods This retrospective study was conducted in five hospitals within the Mount Sinai Health System during March 1, 2020 to July 29, 2020. All patients diagnosed with COVID-19 were included in the study. We identified sarcoidosis patients who met diagnostic criteria for sarcoidosis according to accepted guidelines. An adverse disease outcome was defined as the presence of intubation and mechanical ventilation or in-hospital mortality. In sarcoidosis patients, we reported (when available) the results of pulmonary function testing measured within 3 years prior to the time of SARS‑CoV‑2 infection. A multivariable logistic regression model was used to generate an adjusted odds ratio (aOR) to evaluate sarcoidosis as a risk factor for an adverse outcome. The same model was used to analyze sarcoidosis patients with moderate and/or severe impairment in pulmonary function. Results The study included 7337 patients, 37 of whom (0.5%) had sarcoidosis. The crude rate of developing an adverse outcome was significantly higher in patients with moderately and/or severely impaired pulmonary function (9/14 vs. 3/23, p = 0.003). While the diagnosis of sarcoidosis was not independently associated with risk of an adverse event, (aOR 1.8, 95% CI 0.9–3.6), the diagnosis of sarcoidosis in patients with moderately and/or severely impaired pulmonary function was associated with an adverse outcome (aOR 7.8, 95% CI 2.4–25.8). Conclusion Moderate or severe impairment in pulmonary function is associated with mortality in sarcoidosis patients infected with SARS‑CoV‑2. Electronic supplementary material The online version of this article (10.1007/s00408-020-00392-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam S Morgenthau
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Matthew A Levin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Freeman
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David L Reich
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eyal Klang
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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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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Iriarte A, Rubio-Rivas M, Villalba N, Corbella X, Mañá J. Clinical features and outcomes of asymptomatic pulmonary sarcoidosis. A comparative cohort study. Respir Med 2020; 169:105998. [PMID: 32442109 DOI: 10.1016/j.rmed.2020.105998] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics and outcomes of patients with asymptomatic pulmonary sarcoidosis (APS) detected incidentally and compare them with symptomatic non-Löfgren sarcoidosis (SnLS) patients. METHODS Patients diagnosed as having APS at a University hospital in Barcelona, Spain, followed prospectively from 1976 to 2018. APS was defined as the presence of bilateral hilar lymphadenopathy (BHL) with or without lung parenchymal involvement discovered incidentally on chest radiograph or CT scan. APS was compared with SnLS. RESULTS APS was diagnosed in 50 (13.6%) and SnLS in 317 (86.4%) patients. At diagnosis, stage I chest radiograph was significantly more frequent in APS than in SnLS (p < 0.001) and there were no asymptomatic patients with stages III and IV. SnLS showed more severe impairment in FVC (p = 0.009) and forced expiratory volume in 1st second (FEV1) (p = 0.003) than APS, while DLco was similar in both groups. Extrathoracic involvement at diagnosis and during the follow up was less frequent in APS than in SnLS patients (p < 0.005). Endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS) was the most used diagnostic tool. Treatment was more frequently required in the SnLS than in APS (p < 0.001). At five years, APS patients showed less presence of active disease than SnLS (p = 0.054). CONCLUSIONS APS showed earlier radiological stages, lesser impairment in lung function, extrapulmonary organ involvement and need for treatment than SnLS. EBUS was the most useful diagnostic tool. In spite of its benign presentation, around one third of patients evolved to persistent disease but usually with mild clinical and functional impairment.
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Affiliation(s)
- Adriana Iriarte
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Manuel Rubio-Rivas
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nadia Villalba
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Juan Mañá
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
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Banoei MM, Iupe I, Bazaz RD, Campos M, Vogel HJ, Winston BW, Mirsaeidi M. Metabolomic and metallomic profile differences between Veterans and Civilians with Pulmonary Sarcoidosis. Sci Rep 2019; 9:19584. [PMID: 31863066 PMCID: PMC6925242 DOI: 10.1038/s41598-019-56174-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/08/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a disorder characterized by granulomatous inflammation of unclear etiology. In this study we evaluated whether veterans with sarcoidosis exhibited different plasma metabolomic and metallomic profiles compared with civilians with sarcoidosis. A case control study was performed on veteran and civilian patients with confirmed sarcoidosis. Proton nuclear magnetic resonance spectroscopy (1H NMR), hydrophilic interaction liquid chromatography mass spectrometry (HILIC-MS) and inductively coupled plasma mass spectrometry (ICP-MS) were applied to quantify metabolites and metal elements in plasma samples. Our results revealed that the veterans with sarcoidosis significantly differed from civilians, according to metabolic and metallomics profiles. Moreover, the results showed that veterans with sarcoidosis and veterans with COPD were similar to each other in metabolomics and metallomics profiles. This study suggests the important role of environmental risk factors in the development of different molecular phenotypic responses of sarcoidosis. In addition, this study suggests that sarcoidosis in veterans may be an occupational disease.
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Affiliation(s)
| | - Isabella Iupe
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Reza Dowlatabadi Bazaz
- Department of Biological Science, Bio-NMR-metabolomics Research center, University of Calgary, Calgary, Canada
- Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology, University of Calgary, Calgary, Alberta, Canada
| | - Michael Campos
- Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Hans J Vogel
- Department of Biological Science, Bio-NMR-metabolomics Research center, University of Calgary, Calgary, Canada
- Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology, University of Calgary, Calgary, Alberta, Canada
| | - Brent W Winston
- Department of Biological Science, Bio-NMR-metabolomics Research center, University of Calgary, Calgary, Canada
- Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology, University of Calgary, Calgary, Alberta, Canada
| | - Mehdi Mirsaeidi
- Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA.
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA.
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Abstract
Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.
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Affiliation(s)
- Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Department of Inflammation and Immunity, Lerner Research Institute Cleveland Clinic, Cleveland, OH, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
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Interstitial Lung Disease Group, Chinese Thoracic Society, Chinese Medical Association, Interstitial Lung Disease Working Committee, Chinese Association of Chest Physicians, Chinese Medical Doctor Association. [Chinese expert consensus on the diagnosis and treatment of pulmonary sarcoidosis]. Zhonghua Jie He He Hu Xi Za Zhi 2019; 42:685-93. [PMID: 31484243 DOI: 10.3760/cma.j.issn.1001-0939.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Heyne S, Hägele B, Beissert S, Günther C. Linear Hyperkeratotic Papules on Extremities Together with Oral Ulcers: A Quiz. Acta Derm Venereol 2019; 99:939-940. [PMID: 31197385 DOI: 10.2340/00015555-3239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stefanie Heyne
- Department of Dermatology, University Hospital Dresden, DE-01307 Dresden, Germany.
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Galron E, Grisko O, Zamir D. A Peculiar Case of Abdominal Pain: Clinical Case Education. Isr Med Assoc J 2019; 21:356-361. [PMID: 31140231] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ehud Galron
- Department of Internal Medicine D, Barzilai Medical Center, Ashkelon, Israel
| | - Olga Grisko
- Department of Internal Medicine D, Barzilai Medical Center, Ashkelon, Israel
| | - Doron Zamir
- Department of Internal Medicine D, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Miller ER, Fanta CH, McSparron JI, Pan B, Coblyn JS, Sparks JA. Musculoskeletal and pulmonary outcomes of sarcoidosis after initial presentation of osseous involvement. Sarcoidosis Vasc Diffuse Lung Dis 2019; 36:60-73. [PMID: 30918438 PMCID: PMC6433168 DOI: 10.36141/svdld.v36i1.7326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to investigate the musculoskeletal and pulmonary outcomes of patients with osseous sarcoidosis. METHODS We identified 24 patients with osseous sarcoidosis and at least one year of follow-up after diagnosis (baseline). We collected outcome data at 1-year follow-up and last follow-up. We defined a composite outcome measure; worsening considered as worsening in any of the following 4 components compared to baseline: 1) osseous sarcoidosis symptoms, 2) musculoskeletal imaging of affected bone, 3) chest imaging, or 4) pulmonary function testing (PFT). RESULTS A minority of patients had a worsening composite outcome at 1-year (9/24, 38%) and last follow-up (5/24, 21%). When only considering musculoskeletal symptoms and imaging, only 25% (6/24) and 13% (3/24) of patients worsened compared to baseline at 1-year and last follow-up, respectively. Patients with a worsening composite overall outcome tended to be older at baseline than those without the outcome for both 1-year (54.3 years vs. 47.5 years, p=0.11) and last follow-up (55.0 years vs. 48.7 years; p=0.23), although these differences were non-significant. Treatment was not associated with worsening composite overall outcome at 1-year follow-up (p=0.40), but was significantly associated with decreased risk for worsening at last follow-up (p=0.05). CONCLUSIONS In this retrospective cohort study of osseous sarcoidosis, most patients had a favorable outcome according to symptoms, musculoskeletal/chest imaging, and PFTs, even though only a minority were treated with glucocorticoids or DMARDs. These results suggest that the natural history of osseous sarcoidosis is often benign, although some patients experience clinical progression.
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Affiliation(s)
- Ezra Ross Miller
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | - Christopher H. Fanta
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | | | - Beatrice Pan
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jonathan S. Coblyn
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey A. Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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