Diagnosis Of Sarcoidosis In Patients Research Articles

Moderate or Severe Impairment in Pulmonary Function is Associated with Mortality in Sarcoidosis Patients Infected with SARS‑CoV‑2.

PurposeTo investigate whether sarcoidosis patients infected with SARS-CoV-2 are at risk for adverse disease outcomes.Study Design and MethodsThis retrospective study was conducted in five hospitals within the Mount Sinai Health System during March 1, 2020 to July 29, 2020. All patients diagnosed with COVID-19 were included in the study. We identified sarcoidosis patients who met diagnostic criteria for sarcoidosis according to accepted guidelines. An adverse disease outcome was defined as the presence of intubation and mechanical ventilation or in-hospital mortality. In sarcoidosis patients, we reported (when available) the results of pulmonary function testing measured within 3 years prior to the time of SARS‑CoV‑2 infection. A multivariable logistic regression model was used to generate an adjusted odds ratio (aOR) to evaluate sarcoidosis as a risk factor for an adverse outcome. The same model was used to analyze sarcoidosis patients with moderate and/or severe impairment in pulmonary function.ResultsThe study included 7337 patients, 37 of whom (0.5%) had sarcoidosis. The crude rate of developing an adverse outcome was significantly higher in patients with moderately and/or severely impaired pulmonary function (9/14 vs. 3/23, p = 0.003). While the diagnosis of sarcoidosis was not independently associated with risk of an adverse event, (aOR 1.8, 95% CI 0.9–3.6), the diagnosis of sarcoidosis in patients with moderately and/or severely impaired pulmonary function was associated with an adverse outcome (aOR 7.8, 95% CI 2.4–25.8).ConclusionModerate or severe impairment in pulmonary function is associated with mortality in sarcoidosis patients infected with SARS‑CoV‑2.Electronic supplementary materialThe online version of this article (10.1007/s00408-020-00392-9) contains supplementary material, which is available to authorized users.

Sensitivity and specificity of serum soluble interleukin-2 receptor for diagnosing sarcoidosis in a population of patients suspected of sarcoidosis.

The soluble interleukin 2 receptor (sIL-2R) has been proposed as a marker of disease activity in patients with sarcoidosis. However, no studies have evaluated whether serum sIL-2R measurement is of use in establishing the diagnosis of sarcoidosis in patients who are suspected of sarcoidosis among other diseases. A cohort study was conducted, consisting of new patients who visited the immunology outpatient clinic and whose serum sIL-2R levels were available before a definitive diagnosis was established between February 2011 and February 2016. All patients underwent standard diagnostic testing for sarcoidosis (e.g. laboratory tests, radiographic and/or nuclear imaging and/or affected site biopsy). This resulted either in the diagnosis of sarcoidosis or the exclusion of sarcoidosis with the diagnosis of another disease. Results of sIL-2R and angiotensin-converting enzyme (ACE) levels, radiographic and nuclear imaging and histology results were collected and definitive diagnoses were recorded. Sensitivity, specificity, the concordance statistic from the receiver operating characteristic curve and Youden's Index were calculated to assess the performance of sIL-2R in the diagnosis of sarcoidosis and were compared to ACE, currently one of the most used diagnostic biomarkers in the diagnosis of sarcoidosis. In total 983 patients were screened for inclusion, of which 189 patients met the inclusion criteria. A total of 101 patients were diagnosed with sarcoidosis after diagnostic workup, of whom 79 were biopsy-proven. In 88 patients a diagnosis other than sarcoidosis was made. The sensitivity and specificity of serum soluble interleukin 2 receptor levels to detect sarcoidosis were 88% and 85%. The sensitivity and specificity of ACE were 62% and 76%. Receiver operating characteristic curve analysis revealed that sIL-2R receptor is superior to ACE (p<0.0001). Serum sIL-2R is a sensitive biomarker and superior to ACE in establishing the diagnosis of sarcoidosis and can be used to rule out sarcoidosis in patients suspected of sarcoidosis.

18F-fluorodeoxyglucose positron emission tomography is useful for the diagnosis of intraocular sarcoidosis in patients with a normal CT scan

AimTo assess the usefulness of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) and the predictive factors for the diagnosis of sarcoidosis in patients with uveitis who have normal thoracic tomography.MethodsWe retrospectively...

Uveitis and internuclear ophthalmoplegia as ocular manifestations of sarcoidosis

Sarcoidosis is a multisystemic granulomatous chronic disease of unknown etiology with a wide range of clinical presentations. Diagnosis of sarcoidosis in patients with ocular manifestations can be challenging.We first describe a case of sarcoidosis presented with pulmonary involvement and both uveitis and internuclear ophthalmoplegia as ocular manifestations.A 55-year-old caucasian woman with non-productive cough and weakness presented with bilateral granulomatous anterior uveitis. Few days later, the patient presented again complaining of horizontal diplopia due to internuclear ophthalmoplegia. The diagnosis of sarcoidosis was made as a result of clinical examination and systemic investigations. Particularly, high-resolution computed tomography scanning of the chest was able to identify bilateral hilar lymphadenopathy not previously detected by chest X-ray. Biopsy confirmed diagnosis showing classic non-caseating granulomas.

Multimodal approach to differential diagnosis of breast cancer metastatic lesions: case report

Modern complex and morphological diagnostics are important conditions for optimal therapeutic algorithm development if breast cancer relapse is suspected. This article shows the importance of a multimodal approach to the differential diagnostics of secondary tumor lesions. Modern clinical and radiologic evaluation, interventional technologies, trustworthy morphological investigstion and multidisciplinary teamwork facilitated to make correct diagnosis of sarcoidosis in patient with lesions suspicious for breast cancer relapse and schedule correct treatment.

Sarcoidosis in childhood. A rare systemic disease

Abstract Background Sarcoidosis is a systemic disease of unknown etiology that rarely occurs in children. It usually affects the lungs; however, it may involve various organs. It occasionally affects the general condition, and causes fever, hepatomegaly and splenomegaly. Case report We report the case of a twelve-year-old adolescent with late-onset childhood sarcoidosis which diagnosis was confirmed by lymph node histopathological study. The patient presented general condition, hypercalcemia, erythema nodosum, severe lung disorders, lymphadenopathy, hepatomegaly and testicular mass. He received treatment with steroids, with excellent clinical response. Conclusions We highlight the importance of considering the diagnosis of sarcoidosis in patients with hepatomegaly, lymphadenopathy, diffuse lung damage, erythema nodosum, testicular mass and hypercalcemia, as well as the need for a multidisciplinary approach to assess multiple organ involvement and the early beginning of steroid treatment in order to prevent the progression of the disease.

Liver Function Testing Is Not Useful in the Diagnosis of Sarcoidosis in Patients Presenting with Uveitis

ABSTRACTPurpose: To elucidate the usefulness of abnormal liver function tests in the diagnosis of sarcoidosis in patients presenting with ocular inflammation.Methods: Retrospective comparison of sample populations of 100 patients each with sarcoidosis-associated uveitis (SAU) and non-sarcoid uveitis controls.Results: Number of abnormal results between SAU and control groups were: (1) raised alkaline phosphatase 6:2; (2) raised alanine aminotransferase 21:19; (3) raised total protein 14:5; (4) hypoalbuminemia 0:7; (5) raised bilirubin 1:2. The only parameters reaching statistical significance were in (3), using any elevated result; and (4), the greater risk being in controls.Conclusions: There is no evidence that abnormal liver function tests are an indicator of sarcoidosis in new patients presenting with uveitis.

AB0452 Sarcoidosis: An underestimated and potentially dramatic side effect of anti-TNF-α

BackgroundA 41-year-old woman native from Senegal has a 22-year history of rheumatoid arthritis (RA). The past medical history was marked by a left upper tubercular pneumopathy. In the absence of...

A middle-age woman with subcutaneous plaque and hilar adenopathies

Abstract Subcutaneous sarcoidosis (SS) is an unusual and specific subtype of nodular sarcoidosis 1. The presence of SS with no elements of systemic manifestations is a rare condition: it is reported only in 1.4% to 6% of patients with systemic sarcoidosis, with the trunk being the most predilected area. Such cases with rare presentation are challenging for physicians because it can mimic several chronic infections, amyloidosis, hypothyroidism, lysosomal storage diseases and other conditions. Typical imaging (specially bilateral hilar adenopathies), histological exam and laboratory findings are the baseline to establish the diagnosis of sarcoidosis. In our case, the presence of subcutaneous manifestations avoided the performance of invasive procedures to get confirmation from other target organs: The epithelioid cells granulommas in subcutaneous fat and the representative radiological images were enough features to make the certain diagnosis. The first-line therapy for SS is oral steroids (20–40 mgr/day) with responses observed only 4–8 weeks after initiation of the treatment2. Prognosis of SS is good with spontaneous remission in some cases; however, when granulommas or fibrosis involves vital organs sarcoidosis can be life-threatening. Physicians should consider diagnosis of SS in patients with clinical suspicious history as sometimes skin manifestations are the first sign of systemic presentation of disease

Fluorodeoxyglucose Positron Emission Tomography for the Diagnosis of Sarcoidosis in Patients with Unexplained Chronic Uveitis

Purpose: To assess the value of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) in patients with unexplained chronic uveitis. Methods: Retrospective review of 19 18F-FDG PET scans. All patients had normal chest CT. In the final analysis, the authors used criteria similar to the criteria of Abad et al. (Abad S, Meyssonier V, Allali J, et al. Association of peripheral multifocal choroiditis with sarcoidosis: a study of thirty-seven patients. Arthritis Rheum. 2004;51:974–982) for the diagnosis of sarcoidosis-associated uveitis. Results: Ten (53%) whole-body scans were consistent with sarcoidosis. At the end, subsequent mediastinal biopsies proved sarcoidosis in 3 patients; 2 patients were considered as presumed sarcoidosis, and 6 indeterminate sarcoidosis. Conclusion: 18F-FDG PET may show focal uptake suggestive of sarcoidosis in patients with unexplained uveitis.

Diagnosis of intra-abdominal and mediastinal sarcoidosis with EUS-guided FNA

In the presence of a compatible clinical picture, the diagnosis of sarcoidosis requires pathologic confirmation of noncaseating epithelioid granuloma in affected tissues. The standard procedure of choice for most patients is a bronchoscopy with transbronchial biopsy (TBB), which has a diagnostic yield of 40% to 90%. The lowest yield with TBB is in cases that present with predominant mediastinal or intra-abdominal lymphadenopathy (LN) and minimal parenchymal lung involvement. To study the diagnostic yield of EUS-guided FNA in diagnosing sarcoidosis with predominant LN or masses. Retrospective chart review. Teaching university hospital. Analysis of 21 consecutive patients with sarcoidosis and predominant mediastinal and/or intra-abdominal LN or masses who underwent EUS-guided FNA. EUS-guided FNA diagnosed sarcoidosis in 18 of 21 patients (86%). In 3 patients, EUS-guided FNA was either not diagnostic or inconclusive, and patients underwent mediastinoscopy with lymphadenectomy, which established the diagnosis of sarcoidosis. Seven of the 21 patients (33%) had intra-abdominal LN and/or masses, and EUS-guided FNA of the intra-abdominal pathology was diagnostic of sarcoidosis in 4 of the 7 patients (57%). Four of the 21 patients (19%) had a history of malignancy, and use of EUS-guided FNA helped in ruling out the recurrence of malignancy in 3 of the 4 patients (75%). Mycobacterial and fungal culture was not obtained in all patients. EUS-guided FNA offers a practical, minimally invasive technique for the diagnosis of sarcoidosis in patients who present with predominant mediastinal and/or intra-abdominal LN or masses.

Diagnostic Usefulness of Fluorine–18-α–Methyltyrosine Positron Emission Tomography in Combination With 18F-Fluorodeoxyglucose in Sarcoidosis Patients

L-[3-(18)F]-alpha-methyltyrosine ((18)F-FMT) is an amino-acid tracer for positron emission tomography (PET) and is used for tumor detection because malignant tumor cells accumulate (18)F-FMT based on the increased expression of an amino-acid transporter. This study was conducted to investigate the usefulness of (18)F-FMT PET in combination with fluorine-18-fluorodeoxyglucose ((18)F-FDG) PET for the diagnosis of sarcoidosis in patients with suspected malignancy. Twenty-four sarcoidosis patients with suspected malignancy underwent (18)F-FDG and (18)F-FMT PET. The study included 17 patients with extrapulmonary manifestation mimicking malignant disease (13 patients with systemic lymphadenopathy, 3 of them with concomitant hepatosplenic processes; 3 patients with hepatosplenic processes without concomitant lymphadenopathy; and 1 patient with multiple bone lesions), 3 patients with occurrence of bilateral hilar lymphadenopathy in cancer patients, and 4 patients with multiple nodules mimicking pulmonary metastasis. All patients showed increased uptake of (18)F-FDG and no increase in the accumulation of (18)F-FMT in their lymphadenopathy. Standardized uptake values (SUVs) of (18)F-FDG and (18)F-FMT were 5.01 +/- 2.15 and 0.77 +/- 0.24, respectively (mean +/- SD). All extranodal lesions such as liver, spleen, and bone were visually positive on (18)F-FDG PET and negative on (18)F-FMT PET. No neoplasm was confirmed in all patients. In a control group of patients with lung cancer, SUVs for (18)F-FDG and (18)F-FMT were 6.34 +/- 2.52 and 1.54 +/- 0.82, respectively. The uptake of (18)F-FDG was positive in the sarcoid lesions, and therefore (18)F-FDG PET could not differentiate sarcoidosis from malignant disease. Use of (18)F-FMT PET in combination with (18)F-FDG PET may be the effective method to distinguish sarcoidosis from malignancy.

Diagnosis of Intraabdominal and Mediastinal Sarcoidosis Using Endoscopic Ultrasound Guided Fine Needle Aspiration

Background: In the presence of a compatible clinical picture, the diagnosis of sarcoidosis requires pathologic confirmation of non-caseating epithelioid granuloma in affected tissues. The standard procedure of choice for most patients is bronchoscopy with transbronchial biopsy (TBB), which has a diagnostic yield ranging from 40-90%. The lowest yield with TBB is encountered in cases with predominant mediastinal or intraabdominal lymphadenopathy (LN) and minimal parenchymal lung involvement. In these settings, endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) may provide an alternative diagnostic modality. Methods: Retrospective analysis of 21 patients (10 male and 11 female) with clinical suspicion of sarcoidosis and mediastinal and/or intraabdominal LN or masses on CT who underwent EUS-guided FNA. Results: EUS-guided FNA diagnosed sarcoidosis in 18 out of 21 (86%) patients. In three patient EUS-guided FNA was inconclusive and patients underwent mediastinoscopy with lymphadenectomy which established the diagnosis of sarcoidosis. Five of the 21 patients had intraabdominal LN/masses, and EUS-guided FNA of the intraabdominal pathology was diagnostic of sarcoidosis in three out the five patients (60%). One of the five patients was diagnosed via EUS-guided FNA of mediastinal LN and the other patient via mediastinoscopy. Three of the 21 patients had prior history of malignancy and EUS-guided FNA had ruled out the recurrence of malignancy in this subset of patients. Conclusion: EUS-guided FNA offers a practical, minimally invasive technique for the diagnosis of sarcoidosis in patients presenting with predominant mediastinal or intraabdominal LN or masses.

A positive endomyocardial biopsy result for sarcoid is associated with poor prognosis in patients with initially unexplained cardiomyopathy

Sarcoidosis is a systemic granulomatous disorder of unknown etiology. In patients with cardiomyopathy, the diagnosis of sarcoidosis has important treatment implications. We studied the prognostic implications of a cardiac biopsy diagnosis of sarcoidosis in patients with unexplained cardiomyopathy. We evaluated 1235 patients with unexplained cardiomyopathy who underwent endomyocardial biopsy (EMBx) between 1982 and 1997 at the Johns Hopkins Hospital. Twenty-eight patients were referred with a clinical diagnosis of sarcoidosis. Seven of these 28 patients (25%) plus 3 more with other initial diagnoses had sarcoidosis on heart biopsy. Of these 10 patients, 3 (30%) died with a median survival time after biopsy of 0.69 years. Of the remaining 21 patients with a clinical diagnosis of sarcoidosis, 20 had negative biopsy results for sarcoidosis and 7 (35%) died with a median survival time of 2.34 years. The odds of death within 1, 2, and 3 years were higher for those with than for those without an EMBx-proven cardiac sarcoid (crude OR 4.75 [P = .23], 8.1 [P = .09], and 1.28 [P = .78], respectively), but the differences failed to reach significance at the .05 level. However, the difference in the odds of death within 2 years did achieve marginal significance. Only a quarter of patients with cardiomyopathy and clinical diagnosis of sarcoid have a noncaseating granuloma on EMBx. Of those with a clinical diagnosis of sarcoidosis, heart biopsy results that are positive for sarcoidosis appear to be associated with a shorter median survival time than heart biopsy results that are negative for sarcoidosis. Finally, a noncaseating granuloma on EMBx is a rare finding in patients with cardiomyopathy without a history of sarcoidosis.

Clinical diagnosis of ocular sarcoidosis.

To assess the value of raised serum angiotensin converting enzyme (ACE) levels in making a clinical diagnosis of ocular sarcoidosis in patients with intraocular inflammation, compatible with sarcoidosis, in whom tissue biopsy is either not practical or not possible. The ocular manifestations and clinical course of 22 patients with intraocular inflammation compatible with sarcoidosis and elevated ACE level (including 11 patients with abnormal chest radiograph) were compared with those of a group of 18 patients with intraocular inflammation due to biopsy-proven sarcoidosis. The mean follow-up (+/- SD) was 4.5 +/- 3.4 years in the presumed ocular sarcoidosis group and 7.8 +/- 5.3 years in the biopsy-proven sarcoidosis group. There was no difference in sex, race and age distribution between the two groups. No statistically significant difference could be found between the ocular manifestations seen in each group. The most common finding was retinal vasculitis with panuveitis, seen in 86.4% of the presumed ocular sarcoidosis group and in 83.3% of the biopsy-proven sarcoidosis group. These results suggest that intraocular inflammation compatible with sarcoidosis in conjunction with raised ACE levels would be accordant with a diagnosis of sarcoidosis in patients in whom histological diagnosis is either not practical or not possible.

Ulcerative Sarcoidosis

<h3>Background:</h3> Sarcoidosis is a chronic granulomatous multisystem disease of unknown origin. Cutaneous manifestations are common but ulcerative skin lesions rarely occur. We report a case of generalized ulcerative sarcoidosis in a patient with fatal multisystem involvement. A review of the literature revealed only 34 other cases of ulcerative sarcoidosis, 5 of which were generalized. We reviewed the clinicopathologic spectrum of the disease and available treatment options. <h3>Observations:</h3> Ulcerative sarcoidosis affects women (23 of 35 cases) and blacks (18 of 30 cases) most commonly and occurs in young adulthood. Cutaneous sarcoid lesions, including ulcers (11 of 26 cases), were the presenting complaint in 26 of 35 cases. Ulcers developed both de novo and within other sarcoid lesions. The lower extremities were most often involved (29 of 35 cases). A histological diagnosis was made using skin biopsy specimens in all cases. Corticosteroid therapy seems most effective for treatment of ulcerative sarcoidosis, with methotrexate a proven alternative for refractory cases. <h3>Conclusions:</h3> Dermatologists most often make the initial diagnosis of sarcoidosis in patients with ulcerative lesions. In the proper clinical setting, a skin biopsy of ulcerative lesions establishes the diagnosis and prompt treatment reduces morbidity. Arch Dermatol. 1997;133:215-219

Transbronchial lung biopsy in the diagnosis of suspected ocular sarcoidosis.

We conducted clinical research using transbronchial lung biopsy in 60 patients with suspected ocular sarcoidosis who showed no bilateral hilar lymphadenopathy and sparse contributory evidence for sarcoidosis. The patients had a combination of granulomatous iritis with mutton-fat keratic precipitates or iris nodules, trabecular nodules, tent-like peripheral anterior synechiae, snowball or string-of-pearls vitreous opacities, retinal perivasculitis, and spotty retinochoroidal exudates. The transbronchial lung biopsy specimen showed noncaseating epithelioid granuloma in 37 patients (61.7%); these patients were diagnosed as having sarcoidosis. Bronchoalveolar lavage showed a high percentage of patients with an increased lymphocyte fraction among those with positive transbronchial lung biopsy results. The present results may serve as a basis for a clinical diagnosis of sarcoidosis in patients with suspected sarcoidosis without apparent extraocular manifestations.

Fine‐needle aspiration biopsy: Efficacy in the diagnosis of head and neck sarcoidosis

The authors report the usefulness of fine-needle aspiration biopsy to establish the diagnosis of sarcoidosis in patients with palpable disease in the head and neck areas. Aspiration biopsy proved to be a simple and quick method for establishing this diagnosis in the eight cases reported in this series. Interpretation of cytologic smears with identification of typical sarcoid-like granulomas proved to be quite easy. No complications occurred secondary to use of this technique.

The Kveim test: analysis of results of tests using colindale (K 12) materials.

Results of an analysis are presented of the salient clinical, pathological, and Kveim-test data of importance in the diagnostic assessment of 839 patients in whom a Kveim test was made as part of their routine clinical investigation. From these analyses the following significant observations can be made: 1) The age distribution and negative tuberculin results in patients with sarcoidosis were in keeping with the diagnosis of sarcoidosis, whereas for those in whom a diagnosis other than sarcoidosis was made, they were not. 2) The findings of 64% positive tuberculin results in cases of confirmed sarcoidosis of less than 2 yr known duration and only 39% in those of greater than 2 yr duration are closely similar to those found in international Kveim-test studies reported by Siltzbach in 1966 and Hurley and Bartholomeusz in 1971. 3) The use of the material was helpful in confirming a diagnosis of sarcoidosis in patients with extrathoracic lesions, for positive results were obtained in 33% of those with uveitis 40% of those with erythema nodosum only (findings which are in keeping with those of other studies in the United Kingdom, and 60% among 27 patients presenting with lesions in various sites, including 2 with cranial nerve lesions and one with cardiac arrhythmia. 4) We found only 2 positive reactions (less than 1%) among 221 patients in whom a diagnosis other than sarcoidosis was reached. Clearly these findings show that the Kveim test material. Lots 19 and 22, of spleen K 12 exhibited not only a high degree of reactivity and selectivity for sarcoidosis, but also that they were of considerable practical value as an aid to diagnosis. The finding of only 2(0.9%) positive Kveim tests among 221 patients with diseases other than sarcoidosis is of special interest. Of the different diseases that were ultimately diagnosed only 6 patients tested had lymphoma, only 11 had either pulmonary or lymphatic tuberculosis, and only one had Crohn's disease. Although these numbers are small, it is relevant to compare the Kveim-test data of Lots 19 and 22 of K 12 with those of Lot 5 and of Lot 14 of the same spleen. In validation studies Lot 5 yielded the expected proportion of positive reactions at different stages of sarcoidosis and a negligible proportion of positive reactions with active or quiescent pulmonary tuberculosis or among healthy subjects. However, in subsequent studies in special groups of patients, those with Crohn's disease, ulcerative colitis, or lymphatic tuberculosis, a proportion of the Kveim tests performed with these lots were positive. Within the context of the present field study, the results of these analyses confirm that the last lots of K 12 material exhibited a high degree of selectivity for sarcoidosis and that they emphasize again the practical value of the Kveim tests with suspensions that have undergone careful validation.