Spontaneous Remission Research Articles

PB2301: PEDIATRIC IMMUNE THROMBOCYTOPENIA; A GLANCE AT PATIENTS AND CURRENT THERAPEUTIC CHALLENGES

Background: Immune thrombocytopenia (ITP) during childhood is usually characterized by acute onset of thrombocytopenia with around 75% of children having spontaneous remission within 6 months. Most children experience only mild bleeding in the form of bruising and Petechiae, with severe bleeding being rare even in children with persistent disease Aims: To study demography, clinical, laboratory and treatment options of patients who were newly registered cases of immune thrombocytopenia referred to Children Welfare Teaching Hospital, Medical City, Baghdad. Methods: A retro-prospective descriptive study was done on pediatric patients with ITP who were referred to Children’s Welfare Teaching Hospital (CWTH) / Medical City / Baghdad from January 1, 2020 to August 31, 2021. The period of data collection and follow up started in May 2020 till October 2021. Results: A total of 138 patients were identified as having a presumptive newly diagnosed Immune Thrombocytopenia. Sixteen patients were excluded after being diagnosed as secondary ITP or other causes of thrombocytopenia during observation period. The analysis was limited to 122 patients. The mean age was 4.75 years (range 2 months-13.1 years). There were 63 (51.6%) boys and 59 (48.4%) girls, with a M:F ratio was 1.06:1. The mean duration of symptoms is 13.6 days. Seventy-five (61.5%) patients were managed as an outpatient only. Sole cutaneous bleeding was reported in 57 (46.7%) patients while epistaxis was the leading cause of mucosal bleeding occur in 30 (25%) patients followed by gum bleeding in 15 (12.5%) patients. According to grading, grade I/II was seen in 57 (46.7%). The mean platelet count was 20.2x109/L, Platelet’s count of <30 x109/L in 95 (77.8%) patients. Ninety-three patients (76.2%) reached CWTH without receiving any treatment while 29 (23.8%) patients received treatment elsewhere. The total number of patients kept under watchful waiting strategy was 56 (45.9%). The mean and median platelets count at both time of diagnosis and time of last contact in the observation group were higher than that of the treatment group at time of diagnosis (26 vs 15.4 x 109/L) with a significant statistical correlation, and comparable at time of last follow up (200.7 vs 210.4 x 109/L) with negligible statistical correlation. There was a significant statistical correlation between both groups of patients in regard to the grades of bleeding, the observed group showed grade I\II as the major type of bleeding while the treated group showed grade III as the major type of bleeding. Summary/Conclusion: The result of this study confirms the result of two previous studies in the same center which encourages the successful management of ITP by observation only and support the consensus that ITP is a benign and self-limited condition for the majority of affected children. The incidence of intracranial bleeding was 0.8%. The study observations support the emerging trend toward reserving drug therapy for ITP patients with major bleeding manifestations or troublesome impairment of quality of life.

PUVA therapy in persistent cutaneous histiocytosis: Case report and literature review.

Cutaneous and mucocutaneous histiocytosis (group C) comprise a wide variety of entities affecting skin and/or mucosae. Although they are considered as reactive proliferations, their exact pathophysiology remains unknown and, therefore, they lack a specific treatment. The aim of this study is to review the evidence on cases of histiocytosis treated with UVB and/or UVA and to report a new case of relapsing group C histiocytosis that has been successfully treated with PUVA therapy. We have conducted a review of the literature published over the last 40 years on the treatment of histiocytosis with phototherapy in the online PubMed database. We also describe a new case of successful treatment of histiocytosis with PUVA therapy. Our patient was a 27-year-old man with persistent outbreaks of cutaneous histiocytosis over the previous 8 years. He responded successfully to PUVA therapy, and no relapse has been detected after one year of follow-up. Self-involution is usual in group C histiocytosis, so conservative management is usually the first approach. Relapsing cases pose a therapeutic challenge. Reported treatment options for these patients include isotretinoin, cryotherapy, immunosuppressants, low-dose chemotherapy, CO2 laser, radiotherapy, and surgery. Phototherapy and photochemotherapy have been used in a small number of patients with considerable success. The main limitation to provide firm recommendations on histiocytosis therapy is the absence of solid evidence, as the articles published are mainly case reports with a short follow-up. In our patient, despite the short follow-up we have considered photochemotherapy to be effective since no spontaneous remission had been achieved in the previous 8 years. PUVA therapy could be a safe and effective option to treat persistent cutaneous manifestations in patients with histiocytosis, although more evidence is required to support this statement.

Canine idiopathic orbital inflammation: A case series of four affected dogs (five orbits)

In humans, idiopathic orbital inflammation (IOI) is a diagnosis attributed to benign, inflammatory orbital conditions without identifiable local or systemic cause. We describe the clinical signs, imaging and histopathological findings, management and outcome of four dogs diagnosed with IOI. Multicentric retrospective study. A total of four dogs (five orbits) of three different breeds (three cases were English Springer Spaniels [ESS] or ESS-cross) and ages ranging from 3 to 12 years were included. Initial presenting signs were unilateral and included exophthalmos, enophthalmos, globe deviation, thickening and protrusion of the third eyelid and conjunctival hyperemia. Computed tomography and magnetic resonance imaging identified heterogeneous space-occupying, contrast-enhancing orbital lesions in all cases. Sparing of the retrobulbar space was detected in four of five orbits. Histopathology revealed mixed inflammatory infiltrates of lymphocytes, plasma cells, and histiocytes. Immunohistochemistry was performed in two cases highlighting the presence of histiocytes and lymphocytes, predominantly T cells. Resolution of clinical signs was achieved in two cases managed with oral immunosuppressant medication (corticosteroids alone or combined with cyclosporine or azathioprine), one went into spontaneous remission, one resolved with topical corticosteroids, and one underwent exenteration. Recurrence occurred in two cases within 15months of initial diagnosis and required further immunosuppressant medication. One case developed signs in the contralateral orbit within 8months of presentation. IOI is an uncommon condition in dogs. Its diagnosis relies on the combination of advanced imaging and histology. As in humans, it appears that spontaneous remission and recurrence may occur requiring long-term immunosuppressant medication.

Clinical, imaging and functional determinants of sarcoidosis phenotypes in a Greek population.

BackgroundThe aim of the present study was the application of the latest phenotype recommendations in Greek patients, in order to identify specific clinical, imaging and spirometric characteristics, at initial diagnosis of sarcoidosis, related to disease phenotypes.MethodsOur cohort included 147 patients coming from Northern Greece, recruited from the Outpatient Sarcoidosis Clinic, of Aristotle University of Thessaloniki. The observation period was 5 years. The Scadding staging system and the World Association of Sarcoidosis and other Granulomatous Disorders (WASOG) Clinical Outcome Status instrument were used. Phenotypes were defined by the latest DELPHI consensus recommendations.ResultsThe following clinical phenotypes were identified: asymptomatic 59%, acute 14.3%, chronic 12.9% and advanced 33.3%. The observed phenotypes were not related to Scadding stages. Lung function decline was in line with phenotype severity. The presence of fibrosis to any extent upon diagnosis differed among phenotypes (asymptomatic 13.8%, acute 38.1%, chronic 57.9%, advanced 61.2%, P<0.001) and was common for relapsing patients (P<0.001). In spontaneously remitting patients, fibrosis upon diagnosis was found less often than in non-remitting patients (P<0.001). Renal involvement was more frequently found in the advanced phenotype (P=0.032). Skin involvement was more common for patients with acute onset (P<0.001) and spontaneous remission (P=0.012). Ocular involvement was mainly found in relapsing patients (P<0.001).ConclusionsIn our cohort, sarcoidosis clinical phenotypes have certain clinical, imaging and functional characteristics, at initial diagnosis of the disease, which could be assessed in everyday practice.

Adjuvant therapy for recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a relatively rare disease with potentially devastating consequences for the patient. Its course is unpredictable, ranging from mild disease and spontaneous remission to aggressive disease with pulmonary dissemination and the need for frequent surgery. It can also have a chronic clinical course and cause potentially life-threatening airway damage. A number of alternative medical therapies to standard surgical treatment have been investigated in recent decades, but the results of these studies remain moderate. Recent years have brought significant changes in the incidence of the disease due to breakthroughs in vaccination and prevention of human papillomavirus (HPV) or related pathology. In Poland and many other countries, RRP is not a notifiable disease, hence current data is very limited. It has been accepted to refer to RRP as Juvenile-onset papillomatosis (JoRRP) when the disease occurs in childhood, otherwise it is Adult-onset RRP (AoRRP). This review will present the most promising directions in the fight and prevention of this disease.

Role of Neuron-Specific Enolase in the Diagnosis and Disease Monitoring of Sarcoidosis.

Sarcoidosis is a systemic granulomatous disease of unknown etiology. The diagnosis of sarcoidosis is based on clinicopathologic findings accompanied by the formation of granulomas in multiple organs, including the lung. Although angiotensin-converting enzyme (ACE) and soluble interleukin 2 receptor (sIL-2R) are traditionally used for the diagnosis of sarcoidosis, specific diagnostic markers remain to be determined. In the current study, we found that serum neuron-specific enolase (NSE) levels were elevated in patients with sarcoidosis. Serum NSE levels were positively correlated with serum ACE and sIL-2R levels. The sensitivity of NSE alone was modest, but its combination with sIL-2R and ACE had the highest sensitivity compared to those of each single marker. When comparing serum NSE and pro-gastrin-releasing peptide (ProGRP) levels in SCLC patients with those in patients with sarcoidosis and nonsarcoidotic benign diseases, serum NSE could be used to distinguish SCLC from sarcoidosis and nonsarcoidosis by setting at a cutoff value of 17.0 ng/ml with a sensitivity of 73.5% and a specificity of 90.2%, which were comparable to those of ProGRP. Serum NSE levels were associated with organ involvement and were higher in sarcoidosis patients who had been treated with oral corticosteroid (OCS) than in those who had never received OCS therapies; there was a positive association between elevated serum NSE levels and OCS use. Increased concentrations of serum NSE in patients at the nonremission phase decreased after spontaneous remission, whereas serum NSE levels fluctuated in accordance with serum ACE or sIL-2R levels during the follow-up period in patients with sarcoidosis. These findings suggest that NSE could be a marker for the diagnosis and monitoring of the clinical outcome of patients with sarcoidosis.

TMD in Down Syndrome

Down syndrome is the most common autosomal trisomy with an incidence of 1 in 700 to 800 live births. 1 Hematologic abnormalities are common in Down syndrome. 10% of infants with Down syndrome develop an abnormal myeloproliferative disorder called transient abnormal myelopoiesis (TAM). 2 It occurs because of uncontrolled proliferation of myeloblasts in peripheral blood and bone marrow and is characterized by the presence of GATA-1 mutation along with trisomy 21. The majority of the cases show spontaneous remission without the need for chemotherapy, and only supportive care is required for such cases. We present a newborn with Down syndrome who developed TAM within the first week of life and showed spontaneous remission with supportive care.

The Spontaneous Remission of Recurrent Lymph Node Metastatic Prostate Cancer With Lowering Serum Prostate-Specific Antigen Level

The incidence rate of spontaneous remission of malignant cancer is very low. Reports on spontaneous remission in advanced prostate cancer are extremely limited. Our patient was treated with androgen deprivation therapy, local radiotherapy, and surgical castration at the initial diagnosis. Approximately nine years after treatment, he experienced a rise in serum prostate-specific antigen level and relapse of obturator lymph node adenopathy. Initially, androgen deprivation therapy was reinitiated, which resulted in castration-resistant prostate cancer. Although androgen deprivation therapy was discontinued, spontaneous remission of recurrent lymph node and spontaneous reduction in serum prostate-specific antigen level was seen. There was no sign of radiological recurrence for over eight years without prostate cancer treatment.

Age-related immunosenescence in Behçet's disease.

Behçet's disease (BD) is a systemic vasculitis of unknown etiology causing recurrent mucocutaneous lesions, ocular involvement, central nervous system involvement, and vascular involvement. The disease is characterized by exacerbations and spontaneous remissions. Prognosis is poor in young men when the vessels are involved. The course is more active and severe in the first years of the disease. One of the most interesting features of BD is that the disease changes to a state of low activity and remission over time. Although the association between aging and lower disease activity is well established, there is limited literature data and research investigating the cause. Similarly, there are not many studies on the late onset of BD and its characteristics. In this regard, understanding the cause of the decline in disease activity over time may open new avenues for pathogenesis and treatment research. In this review, we focus on the immunosenescence caused by chronic inflammation and aging in BD. Based on the effect of testosterone on innate immune cells, we also briefly discussed the potential effects of this hormone on vascular involvement.

Transient abnormal myelopoiesis in Down syndrome: Experience of long term follow up from a single tertiary center in Thailand

Transient abnormal myelopoiesis (TAM) is a unique disease occurring in Down syndrome (DS) infants from which most patients have spontaneous remission. This study aimed to evaluate the incidence and outcomes of TAM in a tertiary center in Thailand. We reviewed the records of 997 DS patients diagnosed between June 1993 and October 2019. From the 997 DS patients, 32 had been diagnosed with TAM. The incidence of TAM was 3.2% and an overall survival rate of 87.5%. A total of 2/28 who survived (7.1%) subsequently developed AML-DS at the ages of 2.1 and 4.5 years, respectively. The risk factors related with death included maternal multiparity, sepsis, skin bleeding, subcutaneous nodules, high WBC count, low hemoglobin, and elevated AST level. Abbreviations

ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions.

The International League Against Epilepsy (ILAE) Task Force on Nosology and Definitions proposes a classification and definition of epilepsy syndromes in the neonate and infant with seizure onset up to 2years of age. The incidence of epilepsy is high in this age group and epilepsy is frequently associated with significant comorbidities and mortality. The licensing of syndrome specific antiseizure medications following randomized controlled trials and the development of precision, gene-related therapies are two of the drivers defining the electroclinical phenotypes of syndromes with onset in infancy. The principal aim of this proposal, consistent with the 2017 ILAE Classification of the Epilepsies, is to support epilepsy diagnosis and emphasize the importance of classifying epilepsy in an individual both by syndrome and etiology. For each syndrome, we report epidemiology, clinical course, seizure types, electroencephalography (EEG), neuroimaging, genetics, and differential diagnosis. Syndromes are separated into self-limited syndromes, where there is likely to be spontaneous remission and developmental and epileptic encephalopathies, diseases where there is developmental impairment related to both the underlying etiology independent of epileptiform activity and the epileptic encephalopathy. The emerging class of etiology-specific epilepsy syndromes, where there is a specific etiology for the epilepsy that is associated with a clearly defined, relatively uniform, and distinct clinical phenotype in most affected individuals as well as consistent EEG, neuroimaging, and/or genetic correlates, is presented. The number of etiology-defined syndromes will continue to increase, and these newly described syndromes will in time be incorporated into this classification. The tables summarize mandatory features, cautionary alerts, and exclusionary features for the common syndromes. Guidance is given on the criteria for syndrome diagnosis in resource-limited regions where laboratory confirmation, including EEG, MRI, and genetic testing, might not be available.

Tardive Dyskinesia Arising with Contemporaneous Use of Aripiprazole and Quetiapine in an Adolescent with Intellectual Disability and Its Spontaneous Remission with Treatment Cessation: Case Report

Tardive Dyskinesia Arising with Contemporaneous Use of Aripiprazole and Quetiapine in an Adolescent with Intellectual Disability and Its Spontaneous Remission with Treatment Cessation: Case Report

Proposed Immunology of the Spontaneous Remission of Acute Myleiod

It is suggested that the spontaneous remission of acute myeloid leukemia, particularly hypoplastic acute myeloid leukemia seen after G-CSF treatment is possibly due to G-CSF augmenting an acute inflammatory response. This acute inflammatory response is one occurring during a low count of activated platelets and a low hemoglobulin.

Comparison of infants and children with urolithiasis: a large case series.

We evaluated the demographic features, etiologic risk factors, treatment strategies, and outcome of the infants and children with urolithiasis (UL). A retrospective multicenter study was conducted including 23 Pediatric Nephrology centers in Turkey. The medical records of 2513 children with UL were reviewed. One thousand, three hundred and four boys and 1209 girls (1.1:1) were reported. The mean age at diagnosis was 39.5 ± 35months (0.4-231months), and 1262 patients (50.2%) were in the first year of life (infants). Most of the cases with infantile UL were diagnosed incidentally. Microlithiasis (< 3mm) was found in 794 patients (31.6%), and 64.5% of the patients with microlithiasis were infants. Stones were located in the pelvis-calyces in 63.2% (n: 1530) of the cases. The most common stone type was calcium oxalate (64.6%). Hypocitraturia was the most common metabolic risk factor (MRF) in children older than 12months, but in infancy, hypercalciuria was more common. Fifty-five percent of the patients had received at least one medical treatment, mostly potassium citrate. At the end of a year's follow-up, most of the patients with microlithiasis (85%) showed spontaneous remission. The rate of spontaneous stone resolution in infants was higher than in children. Spontaneous remission rate was higher in cases with MRF (-) stones than in MRF ( +) stones. However, remission rate with medical treatment was higher in cases with MRF ( +) stones. This study represents the results of a large series of infants and children with UL and showed that there are several differences such as underlying metabolic and anatomic abnormalities, clinical course, and stone remission rates between infants and children with urinary stone disease.

Clinical features of dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid in Japan: A nationwide retrospective observational study.

Many cases of bullous pemphigoid (BP) have been reported in patients taking dipeptidyl peptidase-4 inhibitors (DPP-4i), which are the most widely used antidiabetic drug for type 2 diabetes mellitus. However, no large-scale survey has been conducted in Japan. This retrospective study investigated the incidence, clinical presentation, and clinical course of DPP-4i-associated BP (DPP-4i-BP) using epidemiological data from a nationwide registry for BP. In 2016, 713 new BP patients at 94 dermatological institutes were registered, 243 (34.1%) with DPP-4i-BP and 461 (64.7%) with non-DPP-4i-BP. The male-to-female ratio was 1.9 and 0.84, respectively. Patients with DPP-4i-BP were predominantly male. Non-inflammatory BP was more common in DPP-4i-BP (33.3%) than in non-DPP-4i-BP (14.6%), while inflammatory BP was common in both. No specific subtype or difference in disease severity was evident in DPP-4i-BP. The most common gliptins administered to DPP-4i-BP patients were vildagliptin (37.2%) and linagliptin (23.8%). DPP-4i intake was discontinued in 79.9% of cases after diagnosis. Some DPP-4i-BP patients (17.6%) achieved spontaneous remission after discontinuing DPP-4i without requiring the use of systemic corticosteroids and/or adjuvant therapy. Mean duration to achieve disease control was 2.87months. The odds ratio for non-inflammatory BP requiring systemic corticosteroids and/or adjuvant therapy was low (0.52), suggesting that remission was achieved easily with supportive care in that phenotype. Non-inflammatory and mild cases of DPP-4i-BP may resolve spontaneously with supportive care, including the discontinuation of DPP-4i and no oral corticosteroid therapy.

Tyrosine kinase inhibitors for the treatment of indolent systemic mastocytosis: Are we there yet?

Indolent systemic mastocytosis (ISM) is the most prevalent form of systemic mastocytosis. Many patients with ISM suffer from mast cell (MC) mediator-related symptoms. In a small number of patients, hematologic progression is seen in the follow-up. In some patients with ISM, symptoms arising from MC-derived mediators including gastrointestinal symptoms, anaphylaxis, and neuropsychiatric symptoms are kept under control with conventional mediator-targeting drugs or MC-stabilizing agents. However, in a substantial number of patients, the symptoms are refractory to such conventional therapy. For these patients, novel drugs and targeted approaches are considered. One reasonable approach may be to apply tyrosine kinase inhibitors directed against KIT and other key kinase targets expressed in neoplastic MCs in ISM. Because MCs in more than 90% of all patients with typical ISM display the KIT D816V mutant receptor, clinically effective KIT-targeting drugs have to be active against this mutant form of KIT. The 2 such most effective and well-studied agents currently available are midostaurin and avapritinib. Other KIT-targeting drugs, such as imatinib or masitinib, are less effective or even noneffective against KIT D816V and are thus recommended for use only in patients with other KIT mutant forms (noncodon 816 mutations) or with wild-type KIT. In the present article, we review the current state in the treatment of ISM with tyrosine kinase inhibitors, with special emphasis on treatment responses and potential adverse effects. In fact, all of these agents also have unique and common adverse effects, and their use to treat patients with ISM should be balanced against their toxicity and short- and long-term safety.

A stepwise approach for the management of primary erythromelalgia: A prospective single-arm study

A stepwise approach for the management of primary erythromelalgia: A prospective single-arm study

On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity-An observational study.

BackgroundOccasionally, patients show dramatic recovery from disorders of consciousness (DOC) under intrathecal baclofen (ITB), an established treatment option for severe supraspinal spasticity. Anecdotal explanations for ITB‐related recovery of cognition include modulation of afferent impulses at the spinal level, thereby reducing spasticity‐related proprioceptive information overload within cortico–thalamo–cortical connections.ObjectiveIn this retrospective patient chart analysis, we assessed whether a reduction in spasticity would be associated with an increase in Coma Recovery Scale revised (CRS‐R) scores in a larger sample of patients than previously published.MethodsFrom a hospital‐based ITB treatment register, we extracted data from 26 patients with DOC and severe supraspinal spasticity who improved by >2 points on the Coma Recovery Scale revised (CRS‐R) within 6 months after ITB treatment initiation. We assessed Modified Ashworth scale (MAS) scores and CRS‐R scores on admission (PRE) and 3 and 6 months after initiation of ITB treatment (3M, 6M). We performed correlation analysis of the scores and their respective changes (PRE to 3M, 3M to 6M). We also correlated the time from acute event until ITB initiation to CRS‐R scores at 3M and 6M.ResultsITB led to significant improvement in spasticity based on MAS scores, which did not correlate to the improvements seen in CRS‐R total and subscale scores. Daily ITB dose did neither correlate to MAS scores nor to CRS‐total scores in the whole patient group, but after 3 months, ITB dose correlated to some CRS‐R subscale scores in some patient subgroups. Time until ITB treatment did not correlate to CRS‐R scores later on.ConclusionsOur data confirm that ITB may exert beneficial effects in selected DOC patients with respect to improved cognitive functions, which, however, do not correlate to its antispastic effect. The lack of correlation between time to ITB and CRS‐R outcome, but significant CRS‐R improvements following pump implantation, renders spontaneous remissions unlikely and leaves room for alternative pharmacological mechanisms.

Challenges and complexities in designing cluster headache prevention clinical trials: A narrative review.

ObjectiveTo provide a review of challenges in clinical trials for the preventive treatment of cluster headache (CH) and highlight considerations for future studies.BackgroundCurrent guidelines for preventive treatment of CH are largely based on off‐label therapies supported by a limited number of small randomized controlled trials. Guidelines for clinical trial design for CH treatments from the International Headache Society were last issued in 1995.Methods/ResultsRandomized controlled clinical trials were identified in the European and/or United States clinical trial registries with a search term of “cluster headache,” and manually reviewed. Cumulatively, there were 27 unique placebo‐controlled prevention trials for episodic and/or chronic CH, of which 12 were either ongoing, not yet recruiting, or the status was unknown. Of the remaining 15 trials, 5 were terminated early and 7 of the 10 completed trials enrolled fewer patients than planned or did not report the planned sample size. A systematic search of PubMed was also utilized to identify published manuscripts reporting results from placebo‐controlled preventive trials of CH. This search yielded 16 publications, of which 7 were registered. Through critical review of trial data and published manuscripts, challenges and complexities encountered in clinical trials for the preventive treatment of CH were identified. For example, the excruciating pain associated with CH demands a suitably limited baseline duration, rapid treatment efficacy onset, and poses a specific issue regarding duration of investigational treatment period and length of exposure to placebo. In episodic CH, spontaneous remission as part of natural history, and the unpredictability and irregularity of cluster periods across patients present additional key challenges.ConclusionsOptimal CH trial design should balance sound methodology to demonstrate efficacy of a potential treatment with patient needs and the natural history of the disease, including unique outcome measures and endpoint timings for chronic versus episodic CH.

Relapse of Sarcoidosis After Lung Transplantation

<h3>Introduction</h3> Sarcoidosis is a systemic granulomatous disease of unknown etiology. It most commonly affects the lungs, lymph nodes and skin, but the eyes, liver, heart and central nervous system can also be involved. Lung involvement is present in almost all patients with sarcoidosis. Prognosis is generally benign with more than half of patients entering spontaneous remission. However, a third of patients exhibit progressive disease culminating in organ dysfunction. Although sarcoidosis is not among the most frequent causes for lung transplantation, this can be the only therapeutic alternative in this subset of patients. <h3>Case Report</h3> The authors present the case of a 48-year-old caucasian male patient, with no relevant medical history, who had been diagnosed with sarcoidosis since 2006. Thoracic lymph nodes and lung parenchyma were affected on presentation, and screening showed ocular involvement as well. The patient experienced a flare in 2015, with worsened dyspnea and decline in FEV1 and DLCO values, and was started on prednisolone and methotrexate. Clinical stability for the next three years allowed suspension of methotrexate in 2018, while maintaining low dose steroids. However, new clinical and functional decline, as well as detection of cardiac involvement, prompted a six month course of infliximab in 2019. Due to continued worsening of lung function tests (LFTs) and progression to lung fibrosis, the patient underwent bilateral lung transplantation in June 2020 without major complications, and was discharged a month later. He remained asymptomatic and follow-up LFTs were stable until February 2021, eight months after the transplant, when a new fall in FEV1 was noticed. Flexible bronchoscopy and transbronchial biopsies (TBB) were performed, revealing minimal acute rejection (A1) and granulomas compatible with sarcoidosis. Methylprednisolone pulse therapy was administered, followed by weaning. FEV1 levels improved in subsequent evaluations, although TBB performed three months later continued to show signs of sarcoidosis. <h3>Summary</h3> Allograft relapse of sarcoidosis is relatively common - Schultz et al have reported a recurrence rate of 30%. Research by Ionescu et al has showed the granulomas originate from the recipient. Recurrence of sarcoidosis does not seem to impact survival or lung function of lung transplant recipients. This case illustrates coexistence of both acute rejection and recurrent sarcoidosis.