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1.
Artigo em Inglês | MEDLINE | ID: mdl-33093764

RESUMO

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely available diagnostic tool for suspected stage I/II sarcoidosis. Combination of EBUS-TBNA and transbronchial lung biopsy (TBLB) has been proposed as diagnostic procedure in clinical settings. Objectives: The aim of this study was to assess the diagnostic yield of combined EBUS-TBNA and TBLB and identify the markers correlated with a high diagnostic rate. Methods: We retrospectively analyzed the data of 37 patients with suspected stage I/II sarcoidosis with enlarged hilar or mediastinal lymph nodes on computed tomography (CT) images. These patients had been scheduled to undergo EBUS-TBNA and TBLB. Serum levels of sarcoidosis markers (angiotensin-converting enzyme [ACE], soluble interleukin-2 receptor [sIL-2R], and lysozyme), CT findings, and examination techniques were evaluated as predictive markers for diagnosis. Results: Of the 37 patients, 32 had undergone both EBUS-TBNA and TBLB, while the remaining 5 patients had only undergone EBUS-TBNA. The diagnosis was confirmed by TBLB in 16 of the 32 patients (50.0%), EBUS-TBNA in 31 of the 37 patients (83.8%), and combined TBLB and EBUS-TBNA in all patients (100.0%). The serum level of sIL-2R, but not that of ACE or lysozyme, was correlated with successful diagnosis by EBUS-TBNA. Conclusion: In patients with stage I/II sarcoidosis, the serum level of sIL-2R is a promising and useful marker for predicting the diagnosis by EBUS-TBNA and reducing the burden of additional TBLB and its possible complications. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 8-16).


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Receptores de Interleucina-2/sangue , Sarcoidose Pulmonar/sangue , Sarcoidose Pulmonar/patologia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Air Med J ; 39(4): 296-297, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32690307

RESUMO

A 38-year-old emergency medical service Bell 214 male pilot with a dry cough, fever, anorexia, fatigue, and sweating for the past 3 days; an oral temperature of 38°C; blood pressure of 105/65 mm Hg; heart rate of 94 beats/min; respiratory rate of 21 breaths/min; and pulse oximetry of 93% on room air was suspicious for coronavirus disease 2019. Surprisingly, reverse transcription polymerase chain reaction was negative, but bilateral hilar adenopathy was reported in his chest radiography as a new challenge. The pathologic report of the adenopathy biopsy was noncaseating sarcoid-type granulomas. Serologic tests showed a serum angiotensin-converting enzyme level of 58 nmol/mL/min. The bronchoalveolar lavage fluid CD4/CD8 ratio was 3.68. The bronchoalveolar lavage findings provided an accurate sarcoidosis diagnosis, and a high-resolution computed tomographic scan revealed stage 1 pulmonary involvement. Because of the pulmonary involvement, clinical manifestations, use of inhaled fluticasone, and need for longer and accurate follow-up and to protect against coronavirus disease 2019, he has been temporarily suspended until the final assignment.


Assuntos
Resgate Aéreo , Infecções por Coronavirus/diagnóstico , Pilotos , Pneumonia Viral/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Adulto , Betacoronavirus , Técnicas de Laboratório Clínico , Diagnóstico Diferencial , Serviços Médicos de Emergência , Humanos , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Masculino , Mediastino , Pandemias , Sarcoidose Pulmonar/patologia
3.
Am J Respir Crit Care Med ; 201(8): e26-e51, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293205

RESUMO

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.


Assuntos
Cardiomiopatias/diagnóstico , Nefropatias/diagnóstico , Hepatopatias/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Biópsia , Broncoscopia , Cálcio/sangue , Cardiomiopatias/sangue , Cardiomiopatias/fisiopatologia , Creatinina/sangue , Ecocardiografia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Endossonografia , Oftalmopatias/diagnóstico , Oftalmopatias/fisiopatologia , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Nefropatias/sangue , Hepatopatias/sangue , Linfonodos/patologia , Linfadenopatia , Imagem por Ressonância Magnética , Mediastino , Tomografia por Emissão de Pósitrons , Pneumologia , Sarcoidose/sangue , Sarcoidose/diagnóstico , Sarcoidose/patologia , Sarcoidose/fisiopatologia , Sarcoidose Pulmonar/sangue , Sarcoidose Pulmonar/patologia , Sarcoidose Pulmonar/fisiopatologia , Sociedades Médicas , Vitamina D/sangue
4.
Clin Exp Immunol ; 201(1): 85-93, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32275772

RESUMO

Pulmonary sarcoidosis is characterized by an exaggerated CD4+ T cell response and formation of non-necrotizing granulomas. Tumour necrosis factor α (TNF-α) is regarded as crucial for granuloma formation and TNF-α inhibitors offer a third-line treatment option for patients not responding to conventional treatment. However, not all patients benefit from treatment, and an optimal dose and treatment duration have not been established. Insight into the influence of TNF-α inhibitors on lung immune cells may provide clues as to what drives inflammation in sarcoidosis and improve our understanding of treatment outcomes. To evaluate the effects of treatment with the TNF-α inhibitor infliximab on lung immune cells and clinical features of the patients, 13 patients with sarcoidosis refractory to conventional treatment were assessed with bronchoalveolar lavage (BAL), spirometry and computerized tomography (CT) scan closely adjacent to the start of infliximab treatment. These investigations were repeated after 6 months of treatment. Treatment with TNF-α inhibitor infliximab was well tolerated with no adverse events, except for one patient who developed a probable adverse event with liver toxicity. Ten patients were classified as responders, having a reduced CD4/CD8 ratio, a decreased percentage of CD4+ T cells expressing the activation marker CD69 and number of mast cells (P < 0·05 for all). The percentage of T regulatory cells (Tregs ), defined as forkhead box P3+ CD4+ T cells decreased in most patients. In conclusion, six months of infliximab treatment in patients with sarcoidosis led to signs of decreased CD4+ T cell alveolitis and decreased mastocytosis in the lungs of responders.


Assuntos
Infliximab/administração & dosagem , Pulmão/imunologia , Sarcoidose Pulmonar , Linfócitos T Reguladores/imunologia , Adulto , Lavagem Broncoalveolar , Relação CD4-CD8 , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sarcoidose Pulmonar/tratamento farmacológico , Sarcoidose Pulmonar/imunologia , Sarcoidose Pulmonar/patologia , Fatores de Tempo , Tomografia Computadorizada por Raios X
5.
Rev Mal Respir ; 37(3): 214-217, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32146058

RESUMO

Sarcoidosis is a systemic granulomatous disease that can reduce life expectancy mainly due to pulmonary fibrosis resulting from granulomatous inflammation The lack of vascularization within pulmonary granulomas suggests that macrophages localized in the center of these structures are hypoxic. Hypoxia signaling pathways are known to be pro-inflammatory and pro-fibrotic in various pathological conditions. Recent data suggest an involvement of the transcription factor hypoxia-inducible factor (HIF) in the pathogenesis of sarcoidosis. This could represent a new research approach for the understanding and therapeutic management of sarcoidosis.


Assuntos
Hipóxia/complicações , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/patologia , Animais , Progressão da Doença , Humanos , Hipóxia/metabolismo , Hipóxia/patologia , Sarcoidose Pulmonar/metabolismo
9.
Clin Respir J ; 14(1): 16-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605664

RESUMO

BACKGROUND: Sarcoidosis is a multi-system granulomatous disease. The diagnostic procedures for histological confirmation are invasive and a less invasive approach to diagnostic pathway is warranted. The utility of diagnostic value of neck ultrasound was retrospectively evaluated. A histological diagnosis was made by ultrasound-guided head and neck core biopsy to confirm clinically and radiologically suspected sarcoidosis. METHODS: Twenty-five patients were referred for sonographic evaluation of the head and neck after CT scan in an attempt to avoid the use of more invasive tests. These patients had mediastinal adenopathy, but not clinically apparent neck nodes. Where no cervical lymph node suitable for biopsy was seen, parotid glands were biopsied if deemed abnormal. RESULTS: A diagnosis of sarcoidosis was made in all cases where a core biopsy of cervical lymph nodes was attempted. The cervical lymph nodes in this cohort were not particularly enlarged, short-axis dimensions being less than 10mm in majority, and they did not have any sonographic appearances to mark them as pathological. Nevertheless histological examination revealed non-caseating granulomas in all cases. In further two cases, where no neck nodes were seen, a histological diagnosis of sarcoidosis was made from biopsy of diffusely abnormal parotid glands. CONCLUSIONS: Given the clear advantages of cervical diagnosis in terms of invasiveness and economy compared to mediastinal alternatives, it is suggested that where the expertise for core biopsy of normal-sized cervical lymph nodes is readily available, the technique may be considered as a first-line investigation for the diagnosis of sarcoidosis.


Assuntos
Linfonodos/patologia , Mediastino/patologia , Pescoço/patologia , Sarcoidose Pulmonar/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/métodos , Feminino , Granuloma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Glândula Parótida/patologia , Estudos Retrospectivos , Sarcoidose Pulmonar/patologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
11.
Pulm Med ; 2019: 1907807, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827925

RESUMO

Respiratory diseases compromise the health of millions of people all over the world and are strongly linked to the immune dysfunction. CD4+FOXP3+ T regulatory cells, also known as Tregs, have a central role maintaining tissue homeostasis during immune responses. Their activity and clinical impact have been widely studied in different clinical conditions including autoimmune diseases, inflammatory conditions, and cancer, amongst others. Tregs express transcription factor forkhead box P3 (FOXP3), which allows regulation of the immune response through anti-inflammatory cytokines such as IL-10 or transforming growth factor beta (TGF-ß) and direct cell-to-cell interaction. Maintenance of immune tolerance is achieved via modulation of effector CD4+ T helper 1, 2 or 17 (Th1, Th2, Th17) cells by Tregs. This review highlights the recent progress in the understanding of Tregs in different disorders of the respiratory system.


Assuntos
Pulmão/imunologia , Linfócitos T Reguladores/imunologia , Asma/imunologia , Asma/patologia , Citocinas/metabolismo , Fatores de Transcrição Forkhead/metabolismo , Humanos , Fibrose Pulmonar Idiopática/imunologia , Fibrose Pulmonar Idiopática/patologia , Pneumopatias Parasitárias/imunologia , Pneumopatias Parasitárias/patologia , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/patologia , Pneumonia/imunologia , Pneumonia/patologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Doença Pulmonar Obstrutiva Crônica/patologia , Sarcoidose Pulmonar/imunologia , Sarcoidose Pulmonar/patologia
13.
West Afr J Med ; 36(3): 286-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622494

RESUMO

Sarcoidosis is a chronic granulomatous disease with multi-systemic involvement and with varied forms of presentation. The diagnosis can often be a challenge particularly due to the non-specific nature of the disease. It is often silent and may require no active treatment except during flares. We present the case of a middle age lady with pulmonary sarcoidosis who had sudden death from cardiac affectation without prior cardiac symptoms. We concluded that active cardiac assessment is a prudent step in patients presenting with sarcoidosis regardless of the organ of affectation at presentation or diagnosis.


Assuntos
Morte Súbita Cardíaca/etiologia , Sarcoidose Pulmonar/complicações , Cardiomiopatias , Morte Súbita Cardíaca/patologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Sarcoidose Pulmonar/patologia
14.
Sci Rep ; 9(1): 13181, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31515495

RESUMO

Although the pathogenesis of sarcoidosis is not fully understood, immunological characterization has elucidated highly polarized expression of the type 1 T helper cell response. Mucosal-associated invariant T (MAIT) cells are innate T cells that recognize bacterial riboflavin and rapidly produce cytokines such as interferon γ and tumor necrosis factor α. We prospectively evaluated the proportion of MAIT cells and the expression levels of cell surface markers in peripheral blood from 40 sarcoidosis patients and 28 healthy controls. MAIT cells in bronchoalveolar lavage fluid (BALF) were also examined in 12 sarcoidosis patients. In peripheral blood, the proportion of MAIT cells was lower (P = 0.0002), but the expression levels of CD69 and programmed death 1 on MAIT cells were higher in sarcoidosis patients than in healthy controls. Moreover, CD69 expression levels were significantly correlated with clinical biomarkers. Sarcoidosis patients with parenchymal infiltration in the lungs showed a significantly higher proportion and number of MAIT cells in BALF compared to patients without parenchymal infiltration. CD69 expression levels on MAIT cells in BALF were higher than levels in peripheral blood. The activation status of MAIT cells might reflect the disease activity of sarcoidosis. Therefore, it is a potential target for sarcoidosis treatment.


Assuntos
Pulmão/imunologia , Ativação Linfocitária , Células T Invariáveis Associadas à Mucosa/imunologia , Sarcoidose Pulmonar/imunologia , Adulto , Antígenos CD/imunologia , Antígenos de Diferenciação de Linfócitos T/imunologia , Lavagem Broncoalveolar , Citocinas/imunologia , Feminino , Regulação da Expressão Gênica/imunologia , Humanos , Lectinas Tipo C/imunologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Células T Invariáveis Associadas à Mucosa/patologia , Sarcoidose Pulmonar/patologia
16.
Respir Med ; 152: 1-6, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31128602

RESUMO

OBJECTIVES: To describe the clinical features and outcomes in elderly patients with sarcoidosis and to compare them with younger patients. MATERIAL AND METHODS: Retrospective study of a large cohort of 668 consecutive patients with sarcoidosis prospectively collected during 42 years at the Bellvitge University Hospital, a tertiary care single-centre in Barcelona, Spain. Elderly sarcoidosis was defined as sarcoidosis diagnosed in patients ≥65 years-old. RESULTS: Elderly sarcoidosis was diagnosed in 47 (7%) patients. In younger patients, Löfgren's syndrome was the predominant mode of onset (8.5% vs. 42.2%, p < 0.001). At diagnosis, elderly patients more frequently demonstrated radiographic stage III and IV sarcoidosis (21.3% vs. 7.6%, p = 0.001), isolated extrapulmonary involvement (21.3% vs. 8.2%, p = 0.003), subcutaneous nodules (17% vs. 3.4%, p < 0.001) and intraabdominal/retroperitoneal lymph nodes (23.4% vs. 9.5%, p = 0.003). Furthermore, patients with elderly sarcoidosis achieved remission (spontaneous and under treatment) less frequently during the follow-up period (14 patients, 35% vs. 305 patients, 53%, p = 0.027) and had a higher incidence of pulmonary fibrosis (15% vs. 6.1%, p = 0.029). Death related to sarcoidosis was more prevalent in elderly patients (6.4% vs. 1.3%, p = 0.036). CONCLUSIONS: Sarcoidosis in elderly patients requires a high index of suspicion. Aged pulmonary sarcoidosis patients presented with more severe disease at presentation and worse outcomes compared to younger patients. Isolated extrapulmonary involvement at diagnosis and certain particular extrapulmonary organ involvement were more frequent in elderly sarcoidosis. Remission was less frequent in elderly sarcoidosis.


Assuntos
Linfonodos/patologia , Sarcoidose Pulmonar/patologia , Sarcoidose/epidemiologia , Sarcoidose/patologia , Tela Subcutânea/patologia , Adulto , Idoso , Humanos , Incidência , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fibrose Pulmonar/epidemiologia , Fibrose Pulmonar/etiologia , Radiografia Torácica/métodos , Remissão Espontânea , Estudos Retrospectivos , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Sarcoidose Pulmonar/epidemiologia , Espanha/epidemiologia , Centros de Atenção Terciária
17.
Respir Med ; 152: 14-19, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31128604

RESUMO

BACKGROUND: Although it is the general consensus that sarcoidosis patients who present with sarcoidosis-related symptoms have a worse outcome than patients whose disease is detected incidentally without symptoms, this premise has not been rigorously examined. METHODS: Consecutive patients followed longitudinally at one US university sarcoidosis clinic were questioned concerning the onset and description of sarcoidosis-related symptoms at disease presentation. The patients were classified into those with no sarcoidosis-related symptoms at presentation (NSP group) and those with symptoms at presentation (SP group). The following outcomes were examined in the NSP and SP groups: most recent spirometry, organ involvement, need for sarcoidosis therapy, most recent health related quality of life (HRQOL) as measured by the Sarcoidosis Assessment Tool (SAT), most recent chest imaging Scadding stage results. RESULTS: 660 sarcoidosis patients were analyzed, with 175 in the NSP group and 485 in the SP group. Compared to the NSP group, the SP group had a more frequent requirement for any sarcoidosis treatment, corticosteroid treatment, and non-corticosteroid treatment at some time and within the most recent year of follow up (at least 50% more than the NP group with strong statistical differences with p values all 0.01 or less). In addition, the SP group had significantly more organ involvement (p < 0.001) and several worse SAT domains (p < 0.022) than the NP group. There were no differences between the groups in terms of final spirometry or development of Scadding stage 4 chest radiographs. These findings held even after adjusting for age, sex, race, and time between presentation and the most recent follow-up visit using a multivariable logistic regression framework. CONCLUSIONS: In our sarcoidosis cohort, compared to the absence of symptoms at presentation, the presence of symptoms was associated with a greater need for treatment, more organ involvement, and worse HRQOL.


Assuntos
Sarcoidose Pulmonar/patologia , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/patologia , Corticosteroides/uso terapêutico , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida/psicologia , Radiografia Torácica/métodos , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Sarcoidose/tratamento farmacológico , Sarcoidose Pulmonar/diagnóstico por imagem , Sarcoidose Pulmonar/fisiopatologia , Espirometria/métodos
18.
Expert Opin Pharmacother ; 20(11): 1397-1404, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31090462

RESUMO

INTRODUCTION: Sarcoidosis is a granulomatous systemic disease of unknown cause where the lungs are the most frequently affected. Therapeutic management of the disease is challenging as clinical presentation and prognosis are very heterogeneous. AREAS COVERED: This review summarizes the current knowledge of synthetic therapies for pulmonary sarcoidosis. The most commonly used medication for the treatment of sarcoidosis with lung involvement are glucocorticoids. Nevertheless, not all patients reach an acceptable response or tolerate them and the use of second-line treatments like immunosuppressive agents are necessary. Other kind of drugs could be used but there is no solid evidence and most of them are currently under investigation. EXPERT OPINION: The majority of patients with pulmonary sarcoidosis do not require treatment and their sarcoidotic lung lesions could regress. However, it is important to treat the disease in those cases that could develop organ failure. Although the number of studies of therapies for pulmonary sarcoidosis have increased in recent years, the information available is still limited and there is no consensus on how to monitor the activity of the disease.


Assuntos
Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Sarcoidose Pulmonar/tratamento farmacológico , Antimaláricos/uso terapêutico , Humanos , Tecido Parenquimatoso/diagnóstico por imagem , Remissão Espontânea , Sarcoidose Pulmonar/patologia , Esteroides/uso terapêutico
19.
J Investig Med High Impact Case Rep ; 7: 2324709619836139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30938179

RESUMO

INTRODUCTION: Sarcoidosis is a systemic granulomatous inflammatory disease that can involve almost any organ system in the human body. It most frequently presents with pulmonary infiltrates, hilar lymphadenopathy, and skin lesions. Clinical and subclinical involvement of other organ systems is not uncommon. However, the simultaneous development of clinically apparent multisystem sarcoidosis is very rare. CASE DESCRIPTION: This 44-year-old Caucasian man presented to an outpatient clinic with a 2-month history of fatigue, night sweats, weight loss, loss of appetite, and mild abdominal discomfort. Initial laboratory finding showed elevated liver enzymes. Imaging studies revealed cirrhotic liver with steatosis, few enhancing hepatic masses, and multiple enlarged periaortic and portocaval lymph nodes. Liver biopsy revealed scattered necrotizing granulomatous hepatitis. Positron emission tomography scan showed extensive hepatic uptake, diffuse lymphadenopathy, as well as numerous fluorodeoxyglucose-avid osseous lesions. After extensive workup to rule out malignancy and infectious etiologies, a diagnosis of diffuse multi-organ sarcoidosis was made. He was ultimately treated with methotrexate and steroids, resulting in marked improvement in symptoms and liver function, with stable disease on repeat imaging. CONCLUSION: Diffuse multi-organ sarcoidosis is often associated with widespread lymphadenopathy and osseous lesions, which appear indistinguishable from malignancy on imaging. The angiotensin converting enzyme levels and inflammatory markers may be normal. Clinicians should be aware of the possibility of diffuse systemic sarcoidosis in any patient with a remote sarcoidosis history and the simultaneous development of multi-organ-related symptoms.


Assuntos
Doenças Ósseas/patologia , Granuloma/patologia , Hepatopatias/patologia , Linfadenopatia/patologia , Sarcoidose Pulmonar/patologia , Adulto , Biópsia , Doenças Ósseas/complicações , Granuloma/complicações , Humanos , Hepatopatias/complicações , Linfadenopatia/complicações , Masculino , Especificidade de Órgãos , Tomografia por Emissão de Pósitrons , Sarcoidose Pulmonar/complicações
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