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3.
Arch. Soc. Esp. Oftalmol ; 94(9): 453-459, sept. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-186226

RESUMO

Se presenta un caso raro de una mujer caucásica de 29 años con un granuloma en una cicatriz antigua, en la región periocular derecha, como primer signo clínico de una sarcoidosis sistémica. Se procedió a una biopsia escisional de la lesión con diagnóstico anatomopatológico de inflamación crónica granulomatosa no necrosante, con características histológicas sugestivas de sarcoidosis de cicatriz. Al año, la lesión recidivó, por lo que se trató con esteroides depot intralesionales. Esta patología se produce con más frecuencia cuando existen cuerpos extraños y puede ser la primera señal de sarcoidosis sistémica


An unusual case is presented of a 29 year-old Caucasian woman with a granuloma in an old scar in the right periocular region as a first clinical sign of a systemic sarcoidosis. An excisional biopsy was performed, for which the histological diagnosis was a chronic non-necrotising granulomatous inflammation, suggestive of scar sarcoidosis. The lesion re-appeared one year after initial treatment, and was treated with intralesional depot steroids, showing adequate progression. This disease occurs more frequently in wound areas where there are foreign bodies and could be the first sign of systemic sarcoidosis


Assuntos
Humanos , Feminino , Adulto , Cicatriz/patologia , Dermatoses Faciais/diagnóstico , Granuloma de Corpo Estranho/patologia , Sarcoidose/diagnóstico , Anti-Inflamatórios/uso terapêutico , Biópsia , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/patologia , Traumatismos Faciais/complicações , Traumatismos Faciais/patologia , Granuloma de Corpo Estranho/diagnóstico por imagem , Granuloma de Corpo Estranho/etiologia , Imagem por Ressonância Magnética , Recidiva , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triancinolona Acetonida/uso terapêutico , Cicatrização
5.
Clin Nucl Med ; 44(8): 653-654, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274614

RESUMO

Alveolar sarcoidosis is an uncommon radiologic manifestation of pulmonary sarcoidosis which appears as infiltrative or mass-like opacities mimicking multifocal pneumonia or infiltrative lung malignancies such as multi-focal adenocarcinoma or pulmonary lymphoma. It has correlation with a more acute and symptomatic phase of thoracic sarcoidosis and therefore expected to show a more severely increased metabolic activity on FDG PET. Alveolar sarcoidosis shows a relatively rapid radiological improvement after initiation of corticosteroid therapy. Tissue diagnosis might be needed in some cases to exclude malignancy.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Sarcoidose Pulmonar/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Compostos Radiofarmacêuticos
6.
Folia Med (Plovdiv) ; 61(2): 312-316, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301651

RESUMO

BACKGROUND: Sarcoidosis and tuberculosis are chronic diseases that rarely occur concomitantly. We present the case of a 39-year-old woman with microbiological confirmation of pulmonary tuberculosis and concomitant sarcoidosis. Four weeks after corticosteroid therapy for sarcoidosis was introduced we had positive findings of mycobacterium culture from bronchial aspirate. Based on these results, corticosteroid therapy was discontinued and the patient received anti-tuberculosis therapy for six months as required by the national guidelines. During this period, new nodes on face, nose, and ear appeared and the patient was diagnosed with skin sarcoidosis. The patient received colchicine and corticosteroids as per the national guidelines. CONCLUSION: In cases of diagnostic uncertainty between sarcoidosis and tuberculosis we should administer corticosteroid therapy until we have microbiological confirmation of mycobacterium culture.


Assuntos
Sarcoidose Pulmonar/complicações , Tuberculose Pulmonar/complicações , Adulto , Antituberculosos/uso terapêutico , Desprescrições , Etambutol/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Prednisolona/uso terapêutico , Pirazinamida/uso terapêutico , Radiografia Torácica , Rifampina/uso terapêutico , Romênia , Sarcoidose Pulmonar/diagnóstico por imagem , Sarcoidose Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Vitamina B 6/uso terapêutico , Complexo Vitamínico B/uso terapêutico
7.
Semin Ultrasound CT MR ; 40(3): 200-212, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31200869

RESUMO

Sarcoidosis is a multisystem granulomatous process that most commonly involves the lungs. Radiographic findings consistent with sarcoidosis are important to the diagnosis of this disease, as no specific diagnostic test for sarcoidosis exists. The classic imaging manifestations of sarcoidosis are related to granulomatous involvement along the lymphatic pathways within the lungs, granulomatous involvement of lymph nodes, and fibrosis at the sites of previous inflammation. These findings sometimes take atypical forms. Additional manifestations of sarcoidosis are caused by involvement of the bronchi and bronchioles, the pulmonary arteries, and the heart. Fungal colonization may also occur. A range of thoracic imaging manifestations of sarcoidosis is illustrated to facilitate the diagnosis of this common, multifaceted disease.


Assuntos
Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Pulmão/diagnóstico por imagem
8.
Rev. argent. radiol ; 83(2): 77-86, jun. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1020470

RESUMO

La sarcoidosis es una enfermedad granulomatosa no caseificante, multisistémica, de causa desconocida, que compromete al pulmón y a los ganglios linfáticos mediastinales entre el 90 y el 95% de los casos. También puede afectar otros órganos, como las glándulas salivales, piel, ojos, hígado, bazo, corazón, huesos y sistema nervioso central. La sarcoidosis tiene una baja prevalencia en Latinoamérica y es subdiagnosticada debido a la alta frecuencia de otros trastornos similares, como tuberculosis, lepra y micosis profundas. El diagnóstico presuntivo se establece con hallazgos imagenológicos característicos dentro de un contexto clínico apropiado y se confirma con la evidencia histológica de granulomas no caseificantes de células epiteliales, en ausencia de otras etiologías. Los hallazgos torácicos incluyen la afectación pulmonar, ganglionar y bronquial, los cuales son detectados a través de la radiografía (Rx) y tomografía computada (TC) de tórax, siendo esa última más sensible y específica. En este artículo, resaltamos la importancia de reconocer los patrones de presentación típicos y atípicos de la sarcoidosis en Rx y TC, así como la relevancia de las imágenes torácicas como elemento clave en el algoritmo diagnóstico de esa patología. También describimos la utilidad de la resonancia magnética (RM), como método adicional para el diagnóstico en casos de afectación cardíaca y el papel de la tomografía por emisión de positrones (PET-CT) en el seguimiento terapéutico.


Sarcoidosis is a non-caseating granulomatous, multisystemic disease of unknown cause that involves the lung and mediastinal lymph nodes in 90-95% of cases. It can also affect other organs such as the salivary glands, skin, eyes, liver, spleen, heart, bones and the central nervous system. Sarcoidosis has a low prevalence in Latin America and it is underdiagnosed due to the high frequency of other similar disorders such as tuberculosis, leprosy and deep mycosis. The presumptive diagnosis is established based on characteristic imaging findings within an appropriate clinical setting and is confirmed by histological evidence of non-caseating epithelioid cell granulomas, in the absence of other etiologies. Thoracic imaging findings include pulmonary, nodal and bronchial involvement, which are detected on chest radiography (CXR) and computed tomography (CT), this last one having a higher sensitivity and specificity. In this article, we highlight the importance of recognizing the typical and atypical presentation patterns of sarcoidosis on CXR and CT, as well as the relevance of thoracic images as key elements in the diagnostic algorithm of this pathology. We also describe the usefulness of magnetic resonance (MR) imaging as an additional method for diagnosis in cases of cardiac involvement and the role of positron emission tomography (PET-CT) in therapeutic follow-up.


Assuntos
Humanos , Sarcoidose , Sarcoidose/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/métodos , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Sarcoidose/diagnóstico , Radiografia Torácica
9.
Arch Soc Esp Oftalmol ; 94(9): 453-459, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31036427

RESUMO

An unusual case is presented of a 29 year-old Caucasian woman with a granuloma in an old scar in the right periocular region as a first clinical sign of a systemic sarcoidosis. An excisional biopsy was performed, for which the histological diagnosis was a chronic non-necrotising granulomatous inflammation, suggestive of scar sarcoidosis. The lesion re-appeared one year after initial treatment, and was treated with intralesional depot steroids, showing adequate progression. This disease occurs more frequently in wound areas where there are foreign bodies and could be the first sign of systemic sarcoidosis.


Assuntos
Cicatriz/patologia , Dermatoses Faciais/diagnóstico , Granuloma de Corpo Estranho/patologia , Sarcoidose/diagnóstico , Adulto , Anti-Inflamatórios/uso terapêutico , Biópsia , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/patologia , Traumatismos Faciais/complicações , Traumatismos Faciais/patologia , Feminino , Granuloma de Corpo Estranho/diagnóstico por imagem , Granuloma de Corpo Estranho/etiologia , Humanos , Imagem por Ressonância Magnética , Recidiva , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triancinolona Acetonida/uso terapêutico , Cicatrização
13.
Georgian Med News ; (283): 34-38, 2018 Oct.
Artigo em Russo | MEDLINE | ID: mdl-30516487

RESUMO

Immunosuppressants are traditionally administered in sarcoidosis patients with contraindications for the use of glucocorticosteroids (GCS), or in those with serious adverse reactions on GCS, as well as in the cases of GCS-therapy resistance. Aim - to study the effectiveness and safety of methotrexate monotherapy in pulmonary sarcoidosis patients with either GCS contraindication or adverse reactions. We examined 33 patients with st. II pulmonary sarcoidosis, 20 men and 13 women, 23-67 years of age. In all cases a general physical examination; chest computed tomography and spirometry were performed. Oral methotrexate 10 mg once per week was administered to all patients. Blood tests, including total blood count with platelet count, blood chemistry (ALT, AST, bilirubin, creatinin) were done before the start of the therapy and monthly afterwards. Methotrexate monotherapy appeared to be effective in 24 (72,7%) study patients (clinical cure or regression of lung lesions). Adverse reactions were registered in 10 (30,3%) patients. In 1 case treatment was stopped because of the serious adverse event. As it was confirmed by our study results, methotrexate should be considered a medication of choice in pulmonary sarcoidosis patients with contraindications for use or adverse reactions to GCS. A research of combination therapy of methotrexate with first-line drugs should be continued.


Assuntos
Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Sarcoidose Pulmonar/tratamento farmacológico , Adulto , Idoso , Esquema de Medicação , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Masculino , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Sarcoidose Pulmonar/diagnóstico por imagem , Espirometria , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
14.
PLoS One ; 13(11): e0207959, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30475907

RESUMO

PURPOSE: To evaluate the feasibility of quantitative analysis of chest computed tomography (CT) scans for the assessment of lymph node (LN) involvement in patients with pulmonary tuberculosis and sarcoidosis. METHODS: In 47 patients with tuberculosis (n = 26) or sarcoidosis (n = 21), 115 lymph nodes (tuberculous, 55; sarcoid, 60) were visually analyzed on chest CT scans according to their size, location, attenuation and shape. Each node was manually segmented using image analysis tool, which was quantitatively analyzed using the following variables: Feret's diameter, perimeter, area, circularity, mean grey value (Mean), standard deviation (SD) of grey value, minimum grey value (Min), maximum grey value (Max), median grey value (Median), skewness, kurtosis, and net enhancement. We statistically analyzed the visual and quantitative CT features of tuberculous and sarcoid LNs. RESULTS: In visual CT analysis, the mean node size in sarcoidosis was significantly greater than that in tuberculosis. There were no statistical differences between tuberculous and sarcoid LNs in terms of location and shape. Central low attenuation and peripheral rim enhancement were more frequently observed in tuberculous LNs than in the sarcoid ones. In quantitative CT analysis, there were significant differences in the values of the Feret's diameter, perimeter, area, circularity, mean grey value, SD, median, skewness, and kurtosis between tuberculous and sarcoid LNs. CONCLUSIONS: Quantitative CT analysis using CT parameters with pixel-by-pixel measurements can help to differentiate of tuberculous and sarcoid LNs.


Assuntos
Interpretação de Imagem Assistida por Computador , Linfonodos/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
16.
Int J Tuberc Lung Dis ; 22(11): 1374-1377, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30355419

RESUMO

BACKGROUND: Tuberculosis (TB) and sarcoidosis commonly present with pulmonary and ocular involvement. Routine chest radiography (CXR) is recommended in the workup for suspected intraocular TB (IOTB) or intraocular sarcoidosis (IOS); however, data on the utility of CXR in this setting are lacking. METHODS: A post-hoc analysis was performed of a prospectively collected data set comprising 104 patients with uveitis of unknown cause. A pulmonologist and thoracic radiologist, blinded to the final diagnosis, independently reported these CXRs as being in keeping with TB or sarcoidosis. RESULTS: CXRs were reported as normal/indeterminate (n = 88), probable/previous TB (n = 9) or possible/probable sarcoidosis (n = 8), with a 96% inter-observer concordance. CXRs were more often abnormal in IOS than in IOTB (5/8 vs. 5/34, P = 0.01). CXR had a sensitivity of 14.7%, specificity of 94.3%, positive predictive value (PPV) of 55.6% and negative predictive value (NPV) of 69.5% for IOTB, compared with a sensitivity of 62.5%, specificity of 96.9%, PPV of 62.5% and NPV of 96.9% for IOS. Overall diagnostic accuracy was 54.5% (58.1% in human immunodeficiency virus [HIV] positive participants) in the case of IOTB and 79.9% for IOS. CONCLUSION: CXR had high specificity and NPV for IOS, and poor overall diagnostic accuracy for IOTB, including in the HIV-positive population.


Assuntos
Radiografia Torácica , Sarcoidose Pulmonar/diagnóstico por imagem , Tuberculose Ocular/diagnóstico por imagem , Adulto , Feminino , Soropositividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sarcoidose Pulmonar/complicações , Sensibilidade e Especificidade , África do Sul , Tuberculose Ocular/complicações
19.
Endocr Pract ; 24(12): 1110, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30106631
20.
Chest ; 154(2): e45-e48, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30080523

RESUMO

CASE PRESENTATION: A 31-year-old woman presented to the ED with a loss of taste and smell of 2 months' duration and a frontal headache, bilateral facial numbness, photophobia, and horizontal diplopia that was worse with far vision of 2 weeks' duration. A review of systems revealed mild nausea and decreased appetite without weight loss. She denied any cardiopulmonary symptoms, specifically no cough or shortness of breath. Her medical history was notable for arthralgias. The patient was diagnosed with ankylosing spondylitis, for which she had been taking etanercept for several months. She consumed minimal alcohol and had no history of tobacco or drug use or recent travel. Her family history was unremarkable.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico por imagem , Sarcoidose Pulmonar/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Adulto , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/patologia , Diagnóstico Diferencial , Diplopia/etiologia , Feminino , Humanos , Biópsia Guiada por Imagem , Transtornos do Olfato/etiologia , Sarcoidose/complicações , Sarcoidose/patologia , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/patologia , Distúrbios do Paladar/etiologia , Ultrassonografia de Intervenção
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