Setting Of Sarcoidosis Research Articles

SARCOIDOSIS AND HYPERCALCIURIA: A STONE COLD INDICATION FOR TREATMENT

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Sarcoidosis may cause renal disease by several different mechanisms. Symptomatic nephrolithiasis is a rare occurrence as the initial manifestation of sarcoidosis. Hypercalciuria may occur commonly in sarcoidosis and warrants treatment. There is lack of data supporting screening for hypercalciuria. Herein we present a patient with asymptomatic sarcoidosis until she developed nephrolithiasis with a normal serum calcium but an elevated urine calcium. CASE PRESENTATION: 62 year old woman with a history of diabetes mellitus II and obesity was followed in the pulmonology clinic for abnormal chest imaging. She had previously presented to the emergency department for chest pain that lead to a chest radiograph and Chest CT scan. CT scan showed mediastinal adenopathy and pulmonary nodules. Bronchoscopy was performed with biopsies which revealed non necrotizing granulomas consistent with sarcoidosis. Patient had a normal spirogram, and no other extrapulmonary manifestations that would warrant treatment for sarcoidosis. Serum calcium and albumin were normal. 25 hydroxy vitamin D levels were 23 ng/ml. She did take over the counter Vitamin D supplements. Later she developed nephrolithiasis. Analysis of the stone revealed 65% calcium oxalate monohydrate and 15% calcium oxalate dihydrate. A 24 hour urine calcium showed 328 mg of calcium per volume of urine. Patient had a history of diabetes mellitus so treatment with steroids was avoided and she was started on 10 mg of methotrexate. Follow up urine calcium levels are pending. DISCUSSION: While there are guideline recommendations to screen for hypercalcemia with a serum calcium level and for measuring vitamin D levels for replacement, there is scant literature on screening for hypercalciuria in the setting of normal calcium levels, despite hyercalciuria being the most common renal manifestation of renal sarcoidosis. The incidence of renal disease in sarcoidosis varies from 1.1% to 9.7% with hypercalciuria occurring in up to 50% while hypercalcemia may occur in only 10-20% of cases, making hypercalciuria the most common renal manifestation of sarcoidosis. Hypercalciuria is the result of increasing calcium load filtered at glomerulus as a result of decreased PTH secretion secondary to elevated circulating calcitriol levels leading to a diminished tubular reabsorption of calcium. Hypercalciuria predisposes to calcium oxalate nephrolithiasis. Approximately 10 % of patients with sarcoidosis have 1 symptomatic stone. For 1 % of these patients it may be the initial presentation. Approximately 2.7% of sarcoidosis patients have asymptomatic stones. CONCLUSIONS: Hyercalciuria is the most common renal manifestation of sarcoidosis, yet it is not commonly screened for in asymptomatic sarcoidosis patients. Timely treatment may attenuate renal impairment secondary to sarcoidosis. It is suggested that hypercalciuria in the setting of sarcoidosis always be treated. REFERENCE #1: Adam R. Berliner, Mark Haas, Michael J. Choi, Sarcoidosis: The Nephrologist's Perspective, American Journal of Kidney Diseases, Volume 48, Issue 5,2006, Pages 856-870, ISSN 0272-6386, https://doi.org/10.1053/j.ajkd.2006.07.022. REFERENCE #2: Thomas KW, Hunninghake GW. Sarcoidosis. JAMA. 2003 Jun 25;289(24):3300-3. doi: 10.1001/jama.289.24.3300. PMID: 12824213 DISCLOSURES: No relevant relationships by Jonathan gwizdala, source=Web Response Grant for research relationship with Sanofi Please note: January 2021 Added 04/20/2021 by Daniel Ouellette, source=Web Response, value=Grant/Research No relevant relationships by Rajaninder Sharma, source=Web Response

Sarcoidosis and calcium homeostasis disturbances-Do we know where we stand?

The majority of cases involving hypercalcemia in the setting of sarcoidosis are explained by the overproduction of calcitriol by activated macrophages. Vitamin D takes part in the regulation of granuloma formation. However, using vitamin D metabolites to assess the activity of the disease is still problematic, and its usefulness is disputable. In some cases, though, a calcium metabolism disorder could be a valuable tool (i.e. as a marker of extrathoracic sarcoidosis). Although sarcoidosis does not cause a decrease in bone mineral density, increased incidence of vertebral deformities is noted. Despite increasing knowledge about calcium homeostasis disorders in patients with sarcoidosis, there is still a need for clear guidelines regarding calcium and vitamin D supplementation in these patients.

Imaging of hepatobiliary involvement in sarcoidosis.

Sarcoidosis is mainly a disease of the respiratory system; however, several other organ systems may be affected in the course of the disease. Liver is one of the most frequently affected organs in the setting of sarcoidosis after lungs and lymph nodes. Microscopic hepatic involvement is common in these patients but is mostly clinically silent. However, in a significant portion of these patients, macroscopic findings can be detected in the course of the disease, and these findings may easily be confused with other benign and malignant conditions of the liver. The purposes of this article are to briefly summarize the clinical findings and the underlying pathophysiology of sarcoidosis and detailed presentation of the radiologic findings of hepatic involvement in this disease. We subgrouped the imaging findings based on the location and the radiologic appearance of the hepatic involvement. We tried to provide images that would enable the readers to link the imaging findings with the underlying pathology and clinical symptoms.

0325: Early detection of cardiac involvement in sarcoidosis with 2D speckle tracking echocardiography

Cardiac sarcoidosis (CS) is associated with high morbidity and sudden death. Currently, cardiac magnetic resonance (CMR) is the most sensitive method for the diagnosis of CS, however as CMR is being positive relatively late, new imaging methods to improve the early diagnosis of CS are lacking. of this study was to assess the role of left ventricular (LV) strain estimated by 2D speckle tracking imaging in patients with newly diagnosed sarcoidosis without cardiac involvement according to the current guidelines. We performed a prospective cohort study including 10 patients with newly diagnosed sarcoidosis and normal cardiac function as assessed by classic echocardiography and CMR and 10 healthy age- and gender- matched controls. All patients underwent a comprehensive LV strain echocardiographic study. Speckle tracking analysis was performed by 2 experienced cardiologists blinded to each other and to clinical data. Mean age of patients was 53±14 years old (5 women). All patients presented mediastinal lymphadenopathy, 1 had renal involvement and 4 had pulmonary manifestations. Compared with controls, LV longitudinal strain was reduced: long axis longitudinal (-16.1±2.8% vs -21.7±2.2%, p<0.001), 4-chamber LV longitudinal strain (-15±2.8% vs -22.3±1.6%, p<0.001), 2-chamber LV longitudinal strain (-15.8±3.2% vs -20±1.4%, p<0.001) and overall global LV longitudinal strain (-14.4±2.5% vs -21.7±1.4%, p<0.0001). Circumferential LV strain was preserved in patients compared to controls (-21.7±5.4% vs -23.3±2.7%, p=0.5). In this pilot study, Speckle-tracking echocardiography revealed impaired LV longitudinal strain in 100% of patients with normal CMR. Decreased longitudinal LV strain could represent an early sign of myocardial involvement in sarcoidosis patients. Therefore further assessment of cardiac deformation imaging in the setting of sarcoidosis is needed to improve the diagnosis of CS (figure above). Abstract 0325 - Figure: Means values of 4 chamber longitudinal strain (LS-4c) and global longitudinal strain (GLS)

Disseminated cryptococcus with cutaneous involvement in the setting of sarcoidosis associated CD4+ lymphopenia

Disseminated cryptococcus with cutaneous involvement in the setting of sarcoidosis associated CD4+ lymphopenia

Acquired nasopharyngeal stenosis in a patient with sarcoidosis

Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported. A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction. This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.

Intravascular Sarcoidosis Presenting as Pulmonary Vein Occlusion

It is well known that destruction of the distal capillary bed from extensive fibrosis and honeycombing in the setting of sarcoidosis may lead to pulmonary hypertension. However, we report an unusual manifestation of sarcoidosis where pulmonary hypertension resulted from granulomatous involvement of the pulmonary veins and venules. This presented as venous occlusion and intraluminal filling defects that simulated thrombus on chest computed tomography. To our knowledge, this is the first reported imaging case of such a presentation.