Coincidence of Sarcoidosis With Ankylosing Spondylitis in a 48-Year-Old Woman; A Therapeutic Challenge

Gholamhossein Alishiri,Ehsan Rahmanian,Mahsa Ramezanpour

doi:10.34172/hpr.2020.14

Gholamhossein Alishiri, Ehsan Rahmanian + Show 1 more

Open Access

https://doi.org/10.34172/hpr.2020.14

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Abstract

Introduction: A case of pulmonary sarcoidosis is reported because of difficulties in diagnosis and treatment, including the co-existence of ankylosing spondylitis (AS) and severe corticosteroid dependence. Case Presentation: A 48-year-old nonsmoking woman referred to the hospital because of chronic nonproductive cough and dyspnea with a 10-year history of AS. Bilateral rhonchi was detected in lung auscultation. There was a significant limitation in lumbar activity and range of motion in flexion (positive Schober’s test), extension, and lateral bending. In lumbosacral magnetic resonance imaging (MRI), irregularities in the sacroiliac joint and bilateral sacroiliitis were evident. The angiotensin-converting enzyme level was elevated. Biopsy in hilar lymphadenopathy by transbronchial lung biopsy was done, and the histopathological findings showed chronic nonnecrotizing granulomatosis inflammation compatible with sarcoidosis. Anti-tumor necrosis factor drugs was effective on steroiddependent coexisting of sarcoidosis and AS. The symptoms were absent in regular follow up. Conclusion: Pulmonary fibrosis due to sarcoidosis can be prevented by suitable treatment. Clinical trials are needed to confirm the impact of treatments with monoclonal antibodies against tumor necrosis factor (TNF), for curing sarcoidosis.

Highlights

A case of pulmonary sarcoidosis is reported because of difficulties in diagnosis and treatment, including the co-existence of ankylosing spondylitis (AS) and severe corticosteroid dependence
The case of a woman suffering pulmonary sarcoidosis and AS who was responsive to infliximab is reported because of some difficulties in diagnosis and treatment regarding the correlation of the disease with AS, its superimposing to AS, and severe corticosteroid dependence
A point for discussion is that patients suffering pulmonary sarcoidosis and concomitant AS may be treated safely with monoclonal antibody products, which could be useful for suppressing tumor necrosis factor (TNF)-dependent inflammation and subsequent tissue reactions representing as sarcoidosis

Summary

Introduction

A case of pulmonary sarcoidosis is reported because of difficulties in diagnosis and treatment, including the co-existence of ankylosing spondylitis (AS) and severe corticosteroid dependence. Managing pulmonary sarcoidosis is difficult because of four major concerns: (i) it may be subclinical, without any damage to other organs or precise features; (ii) nearly 20% of cases may become aggravated and progress towards pulmonary fibrosis with an increased chance of death; (iii) there is no specific paraclinical index or test for determining the severity and prognosis of lung involvement; and (iv) treatment modalities, including steroids, methotrexate, and anti-tumor necrosis factor (TNF) drugs, have serious side effects.[2,3,4,5,6] Considering these issues, clinical studies have reported multiple steps for curing pulmonary sarcoidosis and preventing pulmonary fibrosis.[7] Researchers have shown that preventing low quality of life caused by pulmonary sarcoidosis is the main reason for clinical interventions.[3]

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Conclusion