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1.
Curr Opin Ophthalmol ; 31(6): 521-531, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009085

RESUMO

PURPOSE OF REVIEW: Ocular sarcoidosis is one of the most common causes of uveitis worldwide. The diagnosis and treatment of patients with ocular sarcoidosis remains challenging in some cases. It is important for clinicians to keep up to date with new diagnostic and treatment tools for this disease. RECENT FINDINGS: The International Workshop on Ocular Sarcoidosis diagnostic criteria were first proposed in 2009 and revised in 2017. The new criteria contained two parts: ocular presentation and systemic investigation. The diagnostic value of liver enzymes was reduced in the new criteria, whereas the value placed of lymphopenia and the CD4/CD8 ratio in bronchoalveolar lavage fluid were increased. Despite not being included in the criteria, recent studies have also highlighted the diagnostic value of serum soluble interleukin-2 receptors. Recent ophthalmologic imaging also provides useful insights for the differential diagnosis.Many new treatments for ocular sarcoidosis have been developed in recent years. The introduction of biological immunomodulatory agents for uveitis treatment represents a big improvement. Antitumor necrosis factor-alpha antibodies, including adalimumab, have been proven to be effective for treating ocular sarcoidosis. Many studies have also suggested that other biological agents could be effective and well tolerated. Newer intravitreal dexamethasone and fluocinolone implants have been developed. Patients treated with these implants have experienced good and sustained control of their intraocular inflammation. SUMMARY: Diagnosis and treatment options for ocular sarcoidosis have changed over time. However, challenges still exist in some difficult patients. Future studies should focus on finding more sensitive biomarkers and developing more effective immunomodulatory treatments with longer efficacy and less side effects.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Biomarcadores/análise , Diagnóstico Diferencial , Endoftalmite/diagnóstico , Humanos
2.
S D Med ; 73(8): 356-358, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32809294

RESUMO

Cardiac sarcoidosis is a rare clinical diagnosis, but can be identified in autopsy in up to a quarter of patients with sarcoidosis. Bradycardia, heart block, and syncope are often the presenting arrhythmias associated with sarcoidosis, but ventricular tachycardia can also occur. We present a patient presenting in ventricular tachycardia, later found to have multi-organ system involvement of sarcoidosis. The patient required pacemaker, implantable cardioverter-defibrillator, and immunosuppression for management of cardiac sarcoidosis. Patients with cardiac sarcoidosis are at elevated risk for arrhythmias, and patients with ventricular tachycardia and reduced ejection fraction should be evaluated for implantable cardioverter-defibrillator. In conclusion, sarcoid cardiomyopathy can present as ventricular tachycardia, and requires evaluation and management targeted at prevention of sudden cardiac death.


Assuntos
Cardiomiopatias , Desfibriladores Implantáveis , Sarcoidose , Taquicardia Ventricular , Morte Súbita Cardíaca , Humanos , Sarcoidose/complicações , Sarcoidose/diagnóstico , Taquicardia Ventricular/etiologia
4.
Ann Biol Clin (Paris) ; 78(4): 454-460, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32616472

RESUMO

Blood angiotensin-converting enzyme (ACE) assay is now realized by the determination of enzyme activity on synthetic substrate, mostly furylacryloyl-phenylalanyl-L-glycyl-L-glycine (FAPGG). The matrix can be serum or heparin-plasma, with or without a separator; the assay developed on serum or plasma is not adapted to other matrix such as cerebrospinal fluid where the ACE activity is much lower. This assay has been adapted on a number of automated biochemistry analyzers with the specifications of the supplier of reagents, sometimes with modification of volumes or times for analysis. Samples can be stored at +4̊C for at least for one week, freezing at -20̊C is possible but refreezing is not advised. The assay is linear from 10 to 200 UI/L. Fidelity is excellent after calibration of the assay. Accuracy can be calculated from IQA and EQA results, and the analytical uncertainty is between 2% and 5% in function of the serum ACE value. Usual values will be soon available from studies on age brackets and sex, because ACE activity seems to be more elevated in boys during adolescence. At signature, it is interesting to have medical information on the diagnosis of sarcoidosis or its treatment including ACE inhibitors as a proof of intake; we can give a commentary on elevation of serum ACE activity from other causes than sarcoidosis and the causes for low activities.


Assuntos
Análise Química do Sangue/métodos , Peptidil Dipeptidase A/análise , Peptidil Dipeptidase A/sangue , Biomarcadores/análise , Biomarcadores/sangue , Análise Química do Sangue/normas , Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/normas , Granuloma/sangue , Granuloma/diagnóstico , Granuloma/terapia , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Fase Pré-Analítica , Reprodutibilidade dos Testes , Sarcoidose/sangue , Sarcoidose/diagnóstico , Sarcoidose/terapia , Sensibilidade e Especificidade , Estudos de Validação como Assunto
5.
Fortschr Neurol Psychiatr ; 88(5): 331-336, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32422672

RESUMO

A 72-year-old woman presented to our emergency centre with acute horizontal diplopia. Neurological examination revealed an isolated abducens nerve paresis on the left. Hilar enlargement seen on the chest x-ray and an elevated serum ACE level led us to suspect sarcoidosis, but the patient declined further evaluation. In the following days, her visual acuity decreased steadily, and she developed cervicothoracic pain, left sided ptosis, weakness of the right arm, and general asthenia. When she was readmitted as an emergency case, neurological examination revealed decreased visual acuity, external ophthalmoplegia and ptosis on the left and a C8 radicular lesion on the right. Imaging studies showed multilocular lesions, e. g. in the left orbital space, spinal epidural manifestations and lymphoma nodular involvement, including retroperitoneally. Laboratory chemistry showed elevated serum levels of ACE, sIL2 receptor and an elevated CD4 / CD8 ratio while bronchoalveolar lavage indicated lymphocytic alveolitis. The biopsy performed under the left M. masseter with a presumptive diagnosis of sarcoidosis, showed a diffuse large-cell B-cell lymphoma. We initiated immuno-chemotherapy following the R-CHOP schema with a curative approach. The case shows the lack of specificity of clinical, imaging and laboratory findings and thus underlines the need for histology in the differential diagnosis of sarcoidosis.


Assuntos
Diplopia/etiologia , Diplopia/fisiopatologia , Sarcoidose/complicações , Sarcoidose/diagnóstico , Idoso , Diagnóstico Diferencial , Diplopia/diagnóstico , Feminino , Humanos , Sarcoidose/fisiopatologia
6.
Neurology ; 94(24): e2545-e2554, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32354749

RESUMO

OBJECTIVE: To characterize a cohort of patients with neurosarcoidosis with particular focus on CSF analysis and to investigate whether CSF values could help in distinguishing it from multiple sclerosis (MS). METHODS: This retrospective cohort study enrolled 85 patients with a diagnosis of neurosarcoidosis (possible, probable, or definite). CSF total protein, white cell count, and angiotensin-converting enzyme levels were measured. CSF and serum oligoclonal immunoglobulin G (IgG) patterns were analyzed with the use of odds ratios and binary logistic regression. RESULTS: Eighty patients had a probable (nonneural positive histology) or definite (neural positive histology) diagnosis of neurosarcoidosis. Most frequent findings on MRI were leptomeningeal enhancement (35%) and white matter and spinal cord involvement (30% and 23%). PET scan showed avid areas in 74% of cases. CSF analysis frequently showed lymphocytosis (63%) and elevated protein (62%), but CSF-selective oligoclonal bands were rare (3%). Serum ACE levels were elevated in 51% of patients but in only 14% of those with isolated neurosarcoidosis. Elevated CSF ACE was not found in any patient. CONCLUSIONS: Large elevations in total protein, white cell count, and serum ACE occur in neurosarcoidosis but are rare in MS. The diagnostic use of these tests is, however, limited because minimal changes may occur in both. MS clinical mimics in neurosarcoidosis are not common, and intrathecal synthesis of oligoclonal IgG is a powerful discriminator because it is rare in neurosarcoidosis but occurs in 95% to 98% cases of MS. We suggest caution in making a diagnosis of neurosarcoidosis when intrathecal oligoclonal IgG synthesis is found.


Assuntos
Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/diagnóstico , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/diagnóstico , Sarcoidose/líquido cefalorraquidiano , Sarcoidose/diagnóstico , Adulto , Idoso , Proteínas do Líquido Cefalorraquidiano/análise , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina G/líquido cefalorraquidiano , Contagem de Leucócitos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Bandas Oligoclonais/líquido cefalorraquidiano , Peptidil Dipeptidase A/sangue , Peptidil Dipeptidase A/líquido cefalorraquidiano , Tomografia por Emissão de Pósitrons , Medula Espinal/diagnóstico por imagem , Adulto Jovem
7.
Hautarzt ; 71(9): 711-714, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32356073

RESUMO

Prior to the introduction of antiretroviral therapy, the concomitant occurrence of sarcoidosis and human immunodeficiency virus (HIV) was extremely rare. Today, an increased prevalence of sarcoidosis as a result of immune reconstitution syndrome (IRIS) is observed in HIV patients. A 37-year-old male patient that was co-infected with HIV and hepatitis C had a 6­month history of gradually progressive asymptomatic periorbital erythematous plaques and papules. Routine clinical examinations were normal. Skin punch biopsy taken from the upper portion of the right cheek showed several non-caseating dermal granulomas with multinucleated giant cells, enabling unequivocal histological diagnosis. Based on the clinical picture and histological findings, the patient was diagnosed with cutaneous sarcoidosis. This case study underlines the change in possible rheumatological and dermatological comorbities in HIV-positive patients treated with highly active antiretroviral therapy. Therefore, physicians treating HIV infections should be familiar with the definition of IRIS.


Assuntos
Granuloma/complicações , Infecções por HIV/complicações , Hepatite C/complicações , Sarcoidose/diagnóstico , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Glucocorticoides/administração & dosagem , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Síndrome Inflamatória da Reconstituição Imune , Masculino , Sarcoidose/complicações , Sarcoidose/tratamento farmacológico
8.
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
9.
Am Heart J ; 223: 106-109, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32240829

RESUMO

BACKGROUND: The diagnosis of cardiac sarcoidosis (CS) is challenging. Because of the current limitations of endomyocardial biopsy as a reference standard, physicians rely on advanced cardiac imaging, multidisciplinary evaluation, and diagnostic criteria to diagnose CS. AIMS: To compare the 3 main available diagnostic criteria in patients clinically judged to have CS. METHODS: We prospectively included patients clinically judged to have CS by a multidisciplinary sarcoidosis team from November 2016 to October 2017. We included only incident cases (diagnosis of CS within 1 year of inclusion). We applied retrospectively the following diagnostic criteria: the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG), the Heart Rhythm Society (HRS), and the Japanese Circulation Society (JCS) 2016 criteria. RESULTS: We identified 69 patients. Diagnostic criteria classified patients as follows: WASOG as highly probable (1.4%), probable (52.2%), possible (0%), some criteria (40.6%), and no criteria (5.8%); HRS as histological diagnosis (1.4%), probable (52.2%), some criteria (40.6%), and no criteria (5.8%); JCS as histological diagnosis (1.4%), clinical diagnosis (58%), some criteria (39.1%), and no criteria (1.4%). Concordance was high between WASOG and HRS (κ = 1) but low between JCS and the others (κ = 0.326). CONCLUSIONS: A high proportion of patients clinically judged to have CS are unable to be classified according to the 3 main diagnostic criteria. There is low concordance between JCS criteria and the other 2 criteria (WASOG and HRS).


Assuntos
Cardiomiopatias/diagnóstico , Sarcoidose/diagnóstico , Adulto , Técnicas de Diagnóstico Cardiovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Monaldi Arch Chest Dis ; 90(1)2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293166

RESUMO

Trans-bronchial needle aspiration allows lymph node sampling in several thoracic conditions; the ability of Rapid On-Site Evaluation (ROSE) to predict the final diagnosis in this setting has not been well characterized. We performed a retrospective study to establish the utility of ROSE in the diagnosis of thoracic diseases with mediastinal lymph node involvement. We retrospectively reviewed 297 patients with hilar-mediastinal lymph node enlargement detected at CT scan from January 2013 to April 2016. 201 patients underwent conventional TBNA; in 96 patients, TBNA procedure was performed by on-site presence of a team of pathologists and research morphologists. Lung neoplasms, sarcoidosis, infections and lymphoma were the most common diseases diagnosed with TBNA samples. TBNA simultaneously performed in combination with ROSE produced an increase in percentage of appropriate samples compared to single cTBNA (adequate samples cTBNA vs ROSE-TBNA: 73% vs 81%; p<0.05). Our observations indicate an increase in adequacy of fine needle aspirations and increased diagnostic yield in the ROSE group. In conclusions, ROSE may serve to reduce procedure time and enhance sample triaging therefore limiting the need for further invasive diagnostic testing.


Assuntos
Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Linfonodos/patologia , Sarcoidose/diagnóstico , Idoso , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/tendências , Feminino , Humanos , Infecções/patologia , Itália/epidemiologia , Neoplasias Pulmonares/patologia , Linfonodos/diagnóstico por imagem , Linfadenopatia/patologia , Linfoma/patologia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Sarcoidose/patologia , Manejo de Espécimes/métodos , Doenças Torácicas/patologia , Tomografia Computadorizada por Raios X/métodos
11.
Rinsho Shinkeigaku ; 60(5): 346-350, 2020 May 26.
Artigo em Japonês | MEDLINE | ID: mdl-32307397

RESUMO

A 68-year-old woman was referred to our hospital for progressive dizziness, gait disturbances and weight loss for 18 months. The patient was alert and showed dysphagia and a marked tendency to fall backward. Electronystagmography showed bilateral vestibular dysfunction and audiometry showed right sensorineural hearing disturbance. Cerebrospinal fluid exam showed mononuclear pleocytosis and elevated protein levels. On 18F-FDG PET/CT, abnormal uptake was observed in the mediastinal lymph nodes, from which biopsy specimens were obtained. Histological findings showed non-caseous granuloma and a diagnosis of bilateral vestibulocochlear, glossopharyngeal and vagal nerve palsies due to neurosarcoidosis was made. Steroid therapy resulted in improvement in her clinical symptoms. Neurosarcoidosis should be included in the differential diagnosis of patients showing progressive easy falling and dysphagia.


Assuntos
Acidentes por Quedas , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/diagnóstico , Transtornos de Deglutição/etiologia , Fragilidade/etiologia , Sarcoidose/complicações , Sarcoidose/diagnóstico , Idoso , Doenças do Sistema Nervoso Central/tratamento farmacológico , Doenças do Sistema Nervoso Central/patologia , Diagnóstico Diferencial , Feminino , Humanos , Leucocitose/etiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prednisolona/administração & dosagem , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Resultado do Tratamento
13.
Clin Ter ; 171(2): e161-e166, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32141489

RESUMO

In patients with sarcoidosis, a lot of researches showed increased levels of the Th1 chemokine monokine induced by interferon (IFN)-γ (MIG) and its (C-X-C motif) receptor (CXCR)3 both in biopsy specimens and bronchoalveolar lavage fluid (BALF). In BALF these levels were associated with CD4(+) and total lymphocytes. Positive CXCR3 ligands staining were found in the alveolar macrophages, and in the epithelioid and giant cells in the sarcoid lungs. It can be assumed that in sarcoid lung the accumulation of Th1 lymphocytes is largely related to MIG. Moreover, the potential role of MIG as a biomarker of sarcoidosis and its severity were proven, given its circulating levels that correlated with the clinical course and gravity of the disease.


Assuntos
Quimiocina CXCL9/metabolismo , Sarcoidose/metabolismo , Líquido da Lavagem Broncoalveolar , Humanos , Macrófagos Alveolares/metabolismo , Receptores CXCR3/metabolismo , Sarcoidose/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Sarcoidose Pulmonar/metabolismo
14.
Rev. chil. enferm. respir ; 36(1): 18-25, mar. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1115458

RESUMO

Las enfermedades granulomatosas incluyen una amplia gama de enfermedades. Sin embargo, en la práctica clínica, muchos casos de enfermedad granulomatosa permanecen sin etiología después del examen histológico. Nuestro objetivo fue determinar, a partir de las biopsias de pulmón, pleura y ganglios linfáticos mediastínicos, en los que se informaron granulomas, las características clínicas y los diagnósticos de estos pacientes. Así también la mortalidad a un año de seguimiento. Metodología: Analizamos retrospectivamente biopsias de pulmón, pleura y/o ganglios linfáticos mediastínicos con granulomas de 75 pacientes del Instituto Nacional del Tórax (2012-2016), sus características clínicas y de laboratorio. La información se obtuvo de los registros médicos. Los datos de mortalidad se obtuvieron del registro civil. Resultados: Se determinó una etiología en todos los casos, excepto en 3 (4%). Los diagnósticos más frecuentes fueron tuberculosis (n = 37; 49%) y sarcoidosis (n = 18; 24%). Otras causas fueron silicosis (5,3%), vasculitis (4%) y neumonitis por hipersensibilidad (2,7%). Los pacientes con tuberculosis (TB) tenían parámetros inflamatorios más altos, como velocidad de eritrosedimentación y proteína C reactiva. Además, sólo se encontraron granulomas con necrosis caseosa en pacientes con tuberculosis. En cambio, los pacientes con sarcoidosis tenían lesiones cutáneas y una mayor frecuencia de linfadenopatías. Cuatro (5.3%) pacientes fallecieron a un año de seguimiento: dos debido a neumonía, uno por hipersensibilidad crónica y uno por TB. Conclusión: La tuberculosis y la sarcoidosis fueron las causas más frecuentes de granulomas respiratorios en este estudio retrospectivo. Se logró determinar una etiología en el 96% de los casos, considerando variables clínicas, de laboratorio e histopatológicas para un diagnóstico diferencial correcto.


Granulomatous diseases comprise a wide range of pathologies. However, in clinical practice, many pulmonary granulomas remain without etiology after the histologic examination. Our aim was to determine from the biopsies of the lung, pleura and mediastinal lymph nodes in which granulomas were reported, the clinical characteristics and diagnoses of the patients. Methodology: We analyzed retrospectively biopsies of the lung, pleura and mediastinal lymph nodes with granulomas from 75 patients handled at our institution (2012-2016), as well as their clinical and laboratory data. The information was obtained from medical records. A one-year mortality date was obtained from the civil registry. Main results: A cause was determined in all the cases, except in three of them (4%). The most frequent diagnoses were tuberculosis (n =37; 49%) and sarcoidosis (n =18; 24%). Other causes were silicosis (5.3%), vasculitis (4%) and hypersensitivity pneumonitis (2.7%). Patients with tuberculosis (TB) had higher inflammatory parameters such as erythrocyte sedimentation rate and C-reactive protein. Besides granulomas with caseous necrosis were only found in TB patients. Instead, patients with sarcoidosis had skin lesions and a higher frequency of lymphadenopathy. Four patients (5.3%) died in a one-year of follow-up: two of them because of pneumonia and the other two patients because of chronic hypersensitivity and TB respectively. Conclusion: Tuberculosis and sarcoidosis were the most common causes of respiratory granulomas in this retrospective study. A specific cause was determined in 96% of cases, considering clinical, laboratory and histopathological variables to do a right differential diagnosis.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Granuloma/diagnóstico , Granuloma/patologia , Pneumopatias/diagnóstico , Pneumopatias/patologia , Sarcoidose/diagnóstico , Sarcoidose/patologia , Tuberculose/diagnóstico , Tuberculose/patologia , Biópsia , Estudos Retrospectivos , Seguimentos , Diagnóstico Diferencial
15.
Intern Med ; 59(11): 1407-1412, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32161217

RESUMO

We herein report a 52-year-old man with multiple hypoechoic lesions in the body and tail of the pancreas detected during a screening ultrasound. Computed tomography (CT) showed no lesions other than those in the pancreas and peripheral lymph nodes. Contrast-enhanced CT identified hypovascular tumors in the pancreas. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) demonstrated partial fibrosis and noncaseating granulomas with Langhans giant cells. To our knowledge, this is the first report of isolated pancreatic sarcoidosis diagnosed by EUS-FNA. Although pancreatic sarcoidosis is very rare, clinicians should be aware of this possibility in patients presenting with multiple hypovascular pancreatic tumors.


Assuntos
Biópsia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Pancreáticas/diagnóstico , Doenças Raras/diagnóstico , Sarcoidose/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Rinsho Shinkeigaku ; 60(3): 213-218, 2020 Mar 31.
Artigo em Japonês | MEDLINE | ID: mdl-32101846

RESUMO

A 62-year-old woman was transported to our hospital for management of generalized clonic seizures. Cerebrospinal fluid examination showed an increased monocyte-dominant cell count, high protein concentration, and low glucose concentration that was 17% of the plasma glucose concentration. Contrast-enhanced cranial magnetic resonance imaging revealed diffuse leptomeningeal enhancement with multiple nodular lesions. She underwent examinations that ruled out the following conditions: tuberculous meningitis, systemic sarcoidosis, malignant lymphoma, carcinomatous meningitis, and central nervous system vasculitis. On hospital day 13, dural and brain biopsies revealed neurosarcoidosis, for which steroid therapy was administered. Thereafter, imaging examinations showed marked improvement. Because isolated neurosarcoidosis is difficult to diagnose, early pathologic diagnosis may be essential.


Assuntos
Encéfalo/patologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/patologia , Sarcoidose/diagnóstico , Sarcoidose/patologia , Tuberculose Meníngea , Biópsia , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Sarcoidose/diagnóstico por imagem
17.
J Neuroimmunol ; 341: 577171, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32007787

RESUMO

Distinguishing neurosarcoidosis (NS) from multiple sclerosis (MS) remains challenging and available parameters lack discriminatory power. Comprehensive flow cytometry data of blood and CSF leukocytes of patients with NS (n = 24), MS (n = 49) and idiopathic intracranial hypertension (IIH, n = 52) were analyzed by machine learning algorithms. NS featured a specific immune cell pattern with increased activated CD4+ T cells in CSF and increased plasma cells in blood. Combining blood and CSF parameters improved the differentiation. We thereby identify and independently validate a multi-dimensional model of blood and CSF supporting the difficult differential diagnosis between NS and MS.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Leucócitos , Esclerose Múltipla/diagnóstico , Sarcoidose/diagnóstico , Adolescente , Adulto , Idoso , Linfócitos T CD4-Positivos/imunologia , Separação Celular , Doenças do Sistema Nervoso Central/sangue , Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/imunologia , Diagnóstico Diferencial , Feminino , Citometria de Fluxo , Humanos , Contagem de Leucócitos , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Modelos Imunológicos , Esclerose Múltipla/sangue , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/imunologia , Estudos Retrospectivos , Sarcoidose/sangue , Sarcoidose/líquido cefalorraquidiano , Sarcoidose/imunologia , Adulto Jovem
18.
Respir Med ; 161: 105846, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32056723

RESUMO

BACKGROUND: In Sweden, sarcoidosis prevalence varies geographically, but it is unclear whether diagnosis and treatment patterns vary by geographical area and calendar period. We sought to investigate differences in sarcoidosis diagnosis and treatment by healthcare region and calendar period using nationwide register data. METHODS: We included 4777 adults who had at least two ICD-coded visits for sarcoidosis in the National Patient Register (2007-2012). We compared patterns of healthcare use (visits and medication dispensations), and data on sarcoidosis diagnosis and treatment spanning two years before to two years after diagnosis stratified by healthcare region and calendar period at diagnosis. RESULTS: Compared to other regions, individuals diagnosed in Stockholm were younger, more likely female, and had a higher education level. In all regions, there was an increase in healthcare use at least six months before sarcoidosis diagnosis with small variation among regions. Most patients were diagnosed in pulmonary and internal medicine outpatient clinics, but compared to the national average more patients were diagnosed in rheumatology in the West and ophthalmology and cardiology in the South. Corticosteroid dispensations at diagnosis varied widely by region (48% in the South/Southeast vs. 30% in Stockholm/North). Demographic factors could not explain these differences. We found no differences by calendar period. CONCLUSION: Our findings suggest a six-month delay in sarcoidosis diagnosis irrespective of region. The observed regional variation likely reflects differences in diagnosis and treatment patterns. Stakeholders should ensure diagnosis and treatment recommendations are closely followed.


Assuntos
Corticosteroides/administração & dosagem , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sarcoidose/epidemiologia , Fatores Sexuais , Suécia/epidemiologia , Fatores de Tempo , Adulto Jovem
19.
J Clin Neurosci ; 73: 308-310, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32081598

RESUMO

The title "great imitator" refers to conditions which can cause varied manifestations and mimic many diseases. Lymphoma is worthy of this title. We describe three cases of lymphoma in which lymphoma mimicked other diseases causing neurological dysfunction, specifically sarcoidosis, vasculitis and infection respectively. Case 1 was a 66-year-old man with subacute progressive diplopia and gait disturbance and investigations revealing a supratentorial para-falcine soft tissue lesion, mid-thoracic cord enhancement and right axillary mass and an elevated serum ACE. Right axillary mass core biopsy was diagnostic of Burkitt lymphoma. Case 2 was a 50-year-old man with several weeks of constitutional symptoms and development of lower limb weakness and numbness, urinary retention and confusion while in hospital. MRI brain demonstrated multi-territory cerebral infarcts. Intravascular lymphoma was diagnosed on random skin biopsy. Case 3 was a 65-year-old man with several weeks of headache and diplopia on a background of previously treated Burkitt lymphoma. CSF analysis showed a lymphocytic pleocytosis and markedly low glucose with cytologic analysis negative for malignancy. Investigations for an infective cause were negative. FDG-PET demonstrated marked, disseminated spinal and cranial leptomeningeal disease and a multi-focal, intra-dural relapse of Burkitt lymphoma was diagnosed. The varied manifestations in our cases demonstrate the ability for lymphoma to mimic infective, inflammatory, granulomatous (including sarcoidosis) and neoplastic aetiologies. An elevated serum ACE appears insufficiently diagnostic to confirm sarcoidosis and tissue for histological examination should be sought whenever possible. When the diagnosis is uncertain, the possibility of this great imitator should be considered, especially for multi-focal disease.


Assuntos
Linfoma/patologia , Recidiva Local de Neoplasia/patologia , Sarcoidose/diagnóstico , Vasculite/diagnóstico , Idoso , Diagnóstico Diferencial , Humanos , Linfoma/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Pele/patologia , Medula Espinal/patologia
20.
Chest ; 157(1): e13-e16, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31916969

RESUMO

CASE PRESENTATION: The patient is a 37-year-old hospital employee and current smoker with a 10 pack-year smoking history, who presented with dyspnea, chest pain, and weight loss. She was in her usual state of health until 4 months prior to admission when she developed intermittent left-sided chest pain, cough productive of scant yellow sputum, fevers, and anorexia. Initial chest radiograph was normal and her outpatient physician prescribed azithromycin, which she took without improvement. One month prior to admission, a follow-up chest radiograph revealed a left-sided upper lobe consolidation; she received a course of levofloxacin without improvement. At follow-up, given her occupation, 13.6-kg unintentional weight loss, and persistent pulmonary symptoms and infiltrate despite treatment for pneumonia, her provider referred her for admission with particular concern for exclusion of active TB. As a hospital employee with clinical exposure, she underwent annual TB screening, which was always negative. She had no known exposure to patients with TB. Her most recent travel was to the Midwestern United States, without significant outdoors exposure. Review of systems was positive for wheezing, anorexia, and arthralgias of both knees and the left ankle and wrist. There was no hemoptysis, leg swelling, visual changes, palpitations, or muscle weakness.


Assuntos
Sarcoidose/diagnóstico , Adulto , Diagnóstico Diferencial , Dispneia , Feminino , Humanos , Baço/patologia , Perda de Peso
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