Typical Sarcoidosis Research Articles

Granulomatous Mastitis: Manifestation of Primary Sarcoidosis Masquerading as Tubercular Mastitis

Sarcoidosis is a multisystem disease of unknown etiology that affects young to middle aged adults, characterized by granuloma formation in various tissues, most commonly the lungs, lymphatics, skin and eyes. Involvement of the breast in sarcoidosis is rare. The breast is involved in less than 1% of cases and can be defined into three subsets, including granulomas localized to the breast, referred to as breast sarcoidosis. Breast can be either a primary or a secondary site of presentation. Breast sarcoidosis often mimics carcinomas at clinical examination. It may present with systemic findings such as erythema nodosum, arthritis, and uveitis, and unlike typical sarcoidosis, commonly manifests during pregnancy. We report a case of breast Sarcoidosis in a 35-year-old lady presenting as recurrent breast abscess with polyarthralgia. On histology, it was characterized by non-caseating giant cell granulomas. Differential diagnoses included idiopathic granulomatous mastitis, tuberculosis, fungal infection, cat-scratch disease, and sarcoid-like reactions to cancer. She was started anti tubercular therapy but responded poorly. Further clinical and laboratory investigations were consistent with a diagnosis of sarcoidosis. Specifically, serum levels of angiotensin-converting enzyme (ACE) were elevated. The patient received treatment with corticosteroid and immunosuppressive, methotrexate and is presently asymptomatic. Breast involvement by sarcoidosis, although rare, should be considered when dealing with granulomatous lesions of the breast.

Diffuse granulomatous disease: looking inside and outside the lungs

A 39-year-old woman presented with a 6-month history of breathlessness, productive cough and painful lumps on her lower legs. She had suffered with recurrent rhinosinusitis and frequent infections of the...

Granulomatous Mastitis as a Presentation of Sarcoidosis

Sarcoidosis is an idiopathic inflammatory disease characterized by granuloma formation in various tissues, most commonly the lungs, lymphatics, skin and eyes. Involvement of the breast in sarcoidosis is rare, and can be defined into three subsets, including granulomas localized to the breast, referred to as breast sarcoidosis. Breast sarcoidosis may present with systemic findings such as erythema nodosum, arthritis, and uveitis, and unlike typical sarcoidosis, commonly manifests during pregnancy. In this report, we present a rare case of breast sarcoidosis presenting in a pregnant female with associated erythema nodosum, arthralgias and ocular complaints.

Cutaneous sarcoidosis presenting with diffuse panniculitis: Report of a case

Cutaneous lesions in sarcoidosis are polymorphic. They can simulate most dermatological conditions. We report a case of cutaneous sarcoidosis presented as diffuse Panniculitis. Case Report: A 62 years patient with no significant past medical history consulted for infiltrated lesion on abdominal skin infiltration lasting for 2 years. On examination, there were multiple indurated plaques, topped with keratotic papules giving an orange peel view, extending on abdominal genitalia and thighs skin associated with lymph nodes enlargement in different sizes and elastic consistence in axillary and inguinal regions. The histopathological examination of the skin lesion and the lymph nodes revealed typical sarcoidosis granulomas. Thoracic abdominal CT scan was normal. After six months of treatment with methotrexate and prednisone, evolution was remarkable by a rapidly skin lesions des infiltration and disappearance of lymphadenopathy. Conclusion: Cutaneous sarcoidosis as disseminated panniculitis is rarely reported in the literature. In our patient, methotrexate combined with prednisone was effective. Other studies have confirmed the efficacy of methotrexate, especially as a steroid sparing treatment. This efficiency would be the result of adenosine production and a decrease in TNF a secretion in granulomatous lesions.

Development of Sarcoidosis Following Completion of Treatment for Hepatitis C with Pegylated Interferon- 2a and Ribavirin: A Case Report and Literature Review

Sarcoidosis is a chronic inflammatory multisystem disease of unknown etiology. We report on a woman, aged 57 years, presenting with typical sarcoidosis occurring two months after completion of a six-month course of interferon-α and ribavirin for chronic hepatitis C virus infection. The current observation is interesting with regard to the time elapsed between the occurrence of symptoms and antiviral treatment withdrawal, and spontaneous recovery after ten months of follow-up. Pathophysiological mechanisms involved in the development of antiviral therapy-induced sarcoidosis are discussed.

Sarcoïdose systémique au décours d’un traitement par interféron-alpha pégylé

A few cases of sarcoidosis have been reported in the course of chronic hepatitis C, with or without alpha-interferon treatment. We report a 54-year-old woman who presented a typical sarcoidosis in this context. The sarcoidosis involved skin, lungs and eyes. There are data in the literature supporting a pathogenic link between alpha-interferon and sarcoidosis: alpha-interferon possessing a non-specific immunologic inductor. The treatment of the sarcoidosis in this context is difficult and has to be adjusted to both the severity of the sarcoidosis and the viral hepatitis. Although sarcoidosis induced by alpha-interferon is rare, clinicians must be aware of this association.

LUPUS PERNIO ON EAR LOBE THAT OCCURED AFTER TRAUMA

In the present 35 years old male patient, there were lupus pernio plaque in the right ear lobe developed after blunt trauma and radiologically typical sarcoidosis findings. In histopatholigical examination, clusters of epithelioid cells scattered irregularly through the dermis were observed. The patient responded well to systemic and topical steroid therapy.

Place de la pathologie granulomateuse au cours des cancers

Purpose Relationships between granulomatosis and cancers have been suspected for a long time. Nevertheless, few evidence has been reported until recently. Here, we present a literature review about the association of granulomatosis and neoplasia. Current knowledge and key points Aside from granulomatosis due to infectious disease, granulomas can be observed in cancer patients, mainly in two situations. Patients may rarely present with typical sarcoidosis occurring before, during or after the diagnosis of cancer. Recent studies have documented such a relationship particularly with lymphomas, testicular and lung cancers, melanomas and hepatocarcinomas. Secondly granulomas may be found as a sarcoid reaction in the vicinity of the tumour itself or more frequently in regional lymph nodes. Sarcoid reaction, reported in Hodgkin's disease and gastric adenocarcinomas, may be associated with a better prognosis. Granulomatous reaction could play an important role in the host's defences against metastatic extension. Immunotherapy such as interferon has been reported to induce systemic sarcoidosis probably by reproducing some physiopathological mechanisms involved in sarcoidosis. Future prospects and projects Clinicians need novel non invasive diagnostic methods to differentiate neoplasia from benign sarcoid reactions. The 18-fluorodeoxyglucose (18-FDG) PET-scan has failed in this indication but the adjunction of a [3-(18)F]-alpha-methyltyrosine ((18)F-FMT) PET-scan could be useful. Biopsies is still necessary in most of cases.

Severe cholestatic granuloumatous hepatitis in sarcoidosis disease with minimal pulmonary involvement

Extrapulmonary manifestations of sarcoidosis are frequently reported. Liver involvement is usually inapparent, with only mild elevation of liver function tests, whereas progressive cholestasis and/or cirrhosis are rarely reported. Sarcoidosis prevalence differs among racial and ethnic groups, and it is known to affect blacks more acutely and more severely than it does people of other races. We report the case of a black nigerian 35-yr old woman, living in Italy since 1988, admitted because fever, itching and increased cholestatic liver tests (GT 1837 IU, ALP 3854 IU, total bilirubin 3.5 mg/dl, AST 71 IU, ALT 84 IU, Cholesterol 448 mg/dl). Abdominal US revealed gallstones and associated cholecystitis, and hepatosplenomegaly. She underwent laparoscopic cholecystectomy: during the procedure an enlarged lymph node close to the gallbladder was collected and a liver biopsy was performed. Histology showed multiple confluent non caseating granulomas, with epitheliod and multinucleated giant cells. All serological and antibodies tests, and microbiological cultures were negative. Chest X-ray, CT and HRCT were normal, whereas abdominal CT confirmed an important hepatosplenomegaly, with numerous hypodense nodular splenic lesions, and hepatic hilar-node enlargement. No significant pulmonary physiologic abnormalities were detected, nevertheless a broncoscopy was performed, with transbronchial lung biopsy and bronco-alveolar-lavage collections. Lung biopsies confirmed the presence of granulomatous involvement and the BAL showed a typical sarcoidosis pattern. Serum ACE (angiotensin-converting-enzyme) activity was 70 U/L. Corticosteroid therapy was started (prednisolone 50 mg daily, with gradual tapering of the dose), plus azatioprine (150 mg daily) and ursodeoxycholic acid (1350 mg daily). After six month of treatment transaminases, bilirubin and ACE levels were in the normal range, whereas GT and ALP decreased significantly (1249 and 1331, respectively). This single case of sarcoidosis presented to the clinician almost exclusively with liver disease; it confirms that in Africans the disease is characterized by more severe extrapulmonary involvement. The consideration of sarcoidosis in such cases is of utmost importance, since the differential diagnosis of hepatic granulomas includes infectious diseases in which treatment with corticosteroids could be fatal.

The pathology of sarcoidosis.

Sarcoidosis is a multisystemic disease characterized by a nonnecrotizing granulomatous inflammatory process that can progress through various stages of activity. The distinctive histology of sarcoidosis is often associated with various morphologic findings in the lung and other organs. The rare variants, necrotizing sarcoidal granulomas and nodular sarcoidosis, share some of the histologic features of typical sarcoidosis, but may have different clinical and pathologic manifestations. The clinician and pathologist should be aware of the diverse pathologic appearances of sarcoidosis.

Fièvre hectique et hyperéosinophilie précédant de quelques mois l'apparition d'une sarcoïdose pulmonaire: forme d'installation atypique?

We report the case of a 34-year-old man, who presented hectic fever and arthralgia, and a few weeks later hypereosinophilia and moderate axonal multiple mononeuropathy of the upper limbs. A typical pulmonary sarcoidosis was found four months later. The relationship between these two syndromes is discussed.

Alternance sarcoïdose/lymphome non hodgkinien : association forfuite ou lien pathogénique ?

A patient was found to have a low-grade non Hodgkin's lymphoma, followed by a typical sarcoidosis, tiself followed by a high-grade non Hodgkin's lymphoma. This succession of diseases does not seem fortuitous and the pathogenic mechanisms are discussed.

Sarcoid pleural effusion: three cases and review of the literature.

Pleural sarcoidosis is rare--it is little recognised in Birtian although several cases have been reported in the international literature. Three white men with pleural effusions caused by sacroidosis have been seen in a two-year period when approximately 60 new cases of thoracic sarcoidosis have been presented. In one patient a recurrent massive effusion was only diagnosed as being caused by sarcoidosis after thoractomy, and in two further patients small symptomatic pleural effusions were present at the onset of typical sarcoidosis. Two patients were successfully treated with steroids and the third improved spontaneously. Percutaneous biopsy is not always helpful in diagnosing pleural sarcoidosis, but a lymphocytic, often blood-stained, pleural aspirate is highly characteristic. While other diseases may coexist, a pleural effusion in a patient with histologically proven sarcoidosis is more likely to be caused by the primary disease than by any other condition.

Posterior lymphadenopathy in sarcoidosis.

Chest radiographs were reviewed in 30 cases of biopsy proven sarcoidosis; posterior mediastinal or para-aortic lymph node enlargement was found in 6 patients (20%) who also had symmetrical hilar and/or paratracheal lymph node enlargement. The radiographic behavior of the hilar, mid- and posterior mediastinal lymph nodes was the same. Posterior mediastinal lymph node enlargement in otherwise typical sarcoidosis is not unusual.