Sarcoidosis: Internal medicine perspective (original) (raw)
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Therapeutic challenges in a case of sarcoidosis
Pneumologia
Sarcoidosis is a chronic systemic inflammatory disease with unknown etiology, whose diagnosis is based on suggestive symptoms/imaging, histopathological examination with non-caseous granuloma, and exclusion of other etiologies. Corticosteroid therapy is the treatment of choice for moderate/severe forms, but medication intolerance or unfavorable evolution may require immunomodulatory therapy. A 40-year-old patient known with poly-allergy was hospitalized for resting dyspnoea, dry cough, night sweats, and itching. Objective examination identifies roughened breathing, wheezing and SpO2 = 98%. Spirometry shows a medium mixed ventilatory dysfunction. Computed tomography (CT) describes multiple mediastinal lymphadenopathies and inhomogeneous hepatomegaly. Osteomedullary biopsy refutes the suspicion of lymphoma. Bronchoscopy detects bronchial hypervascularization. Due to the suggestive imaging context, a transbronchial biopsy was performed (EBUS-TBNA) from the mediastinal lymphadenopathy. ...
Concise Clinical Review A Concise Review of Pulmonary Sarcoidosis
This is an update on sarcoidosis, focusing on etiology, diagnosis, and treatment. In the area of etiopathogenesis, we now have a better understanding of the immune response that leads to the disease as well as genetic factors that modify both the risk for the disease and its clinical outcome. Several groups have also identified possible agents as a cause for sarcoidosis. Although none of these potential causes has been definitely confirmed, there is increasing evidence to support that one or more infectious agents may cause sarcoidosis, although this organism may no longer be viable in the patient. The diagnosis of sarcoidosis has been significantly aided by new technology. This includes the endobronchial ultrasound, which has been shown to increase the yield of needle aspiration of mediastinal and hilar lymph nodes. The positive emission tomography scan has proven useful for selecting possible biopsy sites by identifying organ involvement not appreciated by routine methodology. It has also helped in assessing cardiac involvement. The biologic agents, such as the anti–tumor necrosis factor antibodies, have changed the approach to refractory sarcoidosis. There is increasing evidence that the clinician can identify which patient is most likely to benefit from such therapy. As new and more potent antiinflammatory agents have been developed, it is clear that there are other factors that burden the patient with sarcoidosis, including fatigue and sarcoidosis-associated pulmonary hypertension. There have been several recent studies demonstrating treatment options for these problems.
Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis
Cells
Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25–50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and ren...
A Comprehensive Review of Sarcoidosis Treatment for Pulmonologists
Pulmonary Therapy, 2021
Due to frequent lung involvement, the pulmonologist is often the reference physician for management of sarcoidosis, a systemic granulomatous disease with a heterogeneous course. Treatment of sarcoidosis raises some issues. The first challenge is to select patients who are likely to benefit from treatment, as sarcoidosis may be self-limiting and remit spontaneously, in which case treatment can be postponed and possibly avoided without any significant impact on quality of life, organ damage or prognosis. Systemic glucocorticosteroids (GCs) are the drug of first choice for sarcoidosis. When GCs are started, there is a [ 50% chance of long-term treatment. Prolonged use of prednisone at [ 10 mg/day or equivalent is often associated with severe side effects. In these and refractory cases, steroid-sparing options are advised. Antimetabolites, such as methotrexate, are the second-choice therapy. Biologics, such as anti-TNF and especially infliximab, are third-choice drugs. The three treatments can be used concomitantly. Regardless of whether treatment is started, the clinician needs to organize regular follow-up to monitor remissions, flares, progression, complications, toxicity and relapses in order to promptly adjust the drugs used.
Sarcoidosis- a Clinicoradiological Profile of 30 Patients
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Sarcoidosis is an inflammatory multisystem granulomatous disease of unknown aetiology and predominantly affects the lungs, followed by eye, skin, peripheral lymph node, liver, spleen, heart, central nervous system, musculoskeletal system and salivary glands. Aim-To find out the clinical profile of sarcoidosis patients prospectively admitted to a respiratory unit. MATERIALS AND METHODS The study was conducted on 30 patients of sarcoidosis, who were admitted for various respiratory complaints, in the Department of Pulmonary Medicine, GSVM Medical College, Kanpur & Govt. Medical College, Kannauj. A thorough respiratory evaluation was done including clinical evaluation for signs and symptoms, chest x-ray PA view, HRCT Thorax, Spirometry, sputum for AFB, PPD, serum ACE, serum Calcium, 24-hour urinary calcium, BAL Fluid analysis, CD4 to CD8 of BAL fluid. RESULTS 30 patients of sarcoidosis were evaluated. Of the total patients, male & female were 11 and 19 respectively and ratio was 1:1.7. The mean age of study group was 34.8 years (Range 27-51). Dyspnoea was present in all the patients followed by dry cough (93.3%). Bilateral hilar lymphadenopathy plus pulmonary opacity was the most common radiological presentation of sarcoidosis in 14/30 (46.7%). Pleural effusion was noted in a single case. Extrapulmonary manifestations like subcutaneous nodules were seen in only one case while uveitis also observed in single case only. Sputum for AFB was negative in 2 cases, while others did not raise sputum. PPD testing showed no induration among all, except one where it showed mild induration (6 mm). Serum ACE was elevated in 24/30 patients (86.6%). Serum Calcium was elevated in 10/30 patients (28.6%). 24-hour urinary calcium was elevated in 8/30 patients (26.6%). Spirometry showed a restrictive pattern in 71.4% (i.e. 20/28) and was normal in 17.9% cases while the other three patients did not cooperate. The CD4 to CD8 of BAL fluid levels were raised in all cases of sarcoidosis (range 2.9-4.4). CONCLUSION Bilateral hilar lymphadenopathy plus pulmonary opacity was the most common radiological presentation of sarcoidosis and BAL fluid CD4 to CD8 counts are easy to perform and helpful in supporting diagnosis of sarcoidosis along with clinical and radiological features.
Sarcoidosis: Various Presentations, Coexisting Diseases and Malignancies
Cureus, 2021
Sarcoidosis is a rare, chronic inflammatory disease with a characteristic non-caseating granuloma formation. It affects women more than men. The lung is the most commonly affected organ, however, extrapulmonary involvement is also seen. Sarcoidosis can affect any organ or tissue and can also involve multiple organs simultaneously. As a disease, it shares clinical symptoms with a variety of autoimmune, non-autoimmune disorders and malignancies. Not only it mimics clinically, but it also coexists with these diseases, posing a significant diagnostic challenge. During this literature review, we obtained data from the previously published PubMed articles within the last five years and reviewed the possible etiological association and clinical coexistence between sarcoidosis and other diseases/malignancies. We aimed to determine the common clinical manifestations, various complex presentations of sarcoidosis and pathophysiological considerations for the association, and to emphasize the link with other diseases, particularly thyroid disorders/malignancies. Physicians should be aware of these associated diseases and should always make a clinical suspicion when confronting a sarcoidosis patient. Thus, a comprehensive diagnostic evaluation for these associated conditions ought to be done in sarcoidosis patients to avoid any delay in the curative treatment for these coexisting diseases and to prevent substandard outcomes.
Turkish thoracic journal, 2018
The present study reports the treatment and follow-up results of patients prospectively diagnosed and treated in a public hospital. The present study reports the prospective follow-up data of 21 sarcoidosis cases followed up and treated in the Department of Chest Diseases of Dörtyol State Hospital from January 2010 to December 2014. The 21 cases had a mean age of 44±10 years and a mean follow-up period of 38±13 months. While 10 cases were given steroid treatment, 11 cases were radiologically followed up. Besides pulmonary involvement, skin findings were detected in 7 cases and ophthalmologic findings were detected in 3 cases. In the treatment group, regression was observed in the radiographic findings of 6 cases, while no radiologically significant changes were seen in 4 cases. In the follow-up group, regression was observed in the radiographic findings of 9 cases, while no significant changes were seen in mediastinal LAPs of 2 cases. At the end of the treatment, it was found that 1...
Sarcoidosis - Three Clinical Vignettes with a Short Review
Journal of Nepal Medical Association, 2007
Sarcoidosis is a multi system disorder of unknown cause most commonly affecting the young and middle age adults and frequently presents bilateral hilar lymph-adenopathy. The diagnosis of sarcoidosis is often delayed following the onset of symptoms. The reason being first, the disease is often sub clinical; second as the disease affects any system, the diagnosis of sarcoidosis may not be considered; third, the symptoms are not disease specific hence often treated as other chronic pulmonary diseases; finally economic issues or barriers to access for further workup may affect the timeliness of the diagnosis. No laboratory diagnosis is specific for diagnosing sarcoidosis but histological confirmation from the lymph nodes accessible for biopsy either direct or by intervention may be more specific.
Sarcoidosis--moving to the new standard of diagnosis?
Medicina (Kaunas, Lithuania), 2010
In this article, the most recent literature data regarding the diagnosis of sarcoidosis have been reviewed. The diagnosis of sarcoidosis can be reliably established when there is a compatible clinical/radiological picture together with pathologic evidence of noncaseating epithelioid cell granulomas. Pathologic specimens can be obtained by conventional bronchoscopy with endobronchial, transbronchial lung biopsy, bronchoalveolar lavage, and recently introduced endoscopic ultrasound techniques (endoscopic ultrasound-guided fine-needle aspiration, EUS-FNA, and endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA) or surgical procedures such as thoracotomy, thoracoscopy, and mediastinoscopy. The place and value of EBUS-TBNA or EUS-FNA in diagnosis of sarcoidosis are discussed.
Sarcoidosis: Causes, Diagnosis, Clinical Features, and Treatments
Journal of Clinical Medicine
Sarcoidosis is a multisystem granulomatous disease with nonspecific clinical manifestations that commonly affects the pulmonary system and other organs including the eyes, skin, liver, spleen, and lymph nodes. Sarcoidosis usually presents with persistent dry cough, eye and skin manifestations, weight loss, fatigue, night sweats, and erythema nodosum. Sarcoidosis is not influenced by sex or age, although it is more common in adults (< 50 years) of African-American or Scandinavians decent. Diagnosis can be difficult because of nonspecific symptoms and can only be verified following histopathological examination. Various factors, including infection, genetic predisposition, and environmental factors, are involved in the pathology of sarcoidosis. Exposures to insecticides, herbicides, bioaerosols, and agricultural employment are also associated with an increased risk for sarcoidosis. Due to its unknown etiology, early diagnosis and detection are difficult; however, the advent of adva...