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Transient Sarcoidosis

Sarcoidosis Primary Transient


Presentation

  • Abstract We report a patient who experienced multiple transient ischemic attacks (TIAs) over a 3-month period as the presenting clinical manifestation of sarcoidosis.[ncbi.nlm.nih.gov]
  • ; most commonly, it presents as cranial neuropathy, but presentation ranges from encephalopathy, meningitis, hydrocephalus, and seizure to spinal cord dysfunction, peripheral neuropathy, and myopathy. 2, 3, 4, 10 Only rare cases of neurosarcoidosis presenting[ajnr.org]
  • Here, we present a case of isolated neurosarcoidosis that initially presented with hydrocephalus requiring ventriculoperitoneal shunt placement.[nnjournal.net]
  • Splenomegaly is present in about 17%. In approximately12%, osseous granulomas are present, most commonly in the phalanges of the fingers and toes. Involved phalanges appear swollen and deformed, often sausage-shaped.[dermaamin.com]
  • Case Report Mrs BM, a 52 year old lady presented in March 2008 to the ENT department at Royal Glamorgan Hospital, South Wales.[ispub.com]
Inflammation
  • The lymphadenopathy specimens were biopsied via mediastinoscopy, and histological study revealed noncaseating epithelioid granulomatous inflammation consistent with sarcoidosis.[ncbi.nlm.nih.gov]
  • Treatment is directed at reducing inflammation and managing any heart problems caused by inflammation and granulomas.[heart.templehealth.org]
  • Several studies have shown the central role of inflammation in diabetes.[care.diabetesjournals.org]
  • […] with fibrosis, and disruption and atrophy of the muscle fibers. muscular sarcoidosis the formation of epithelioid tubercles in the skeletal muscles, characterized by interstitial inflammation, fibrosis, atrophy, and damage to the muscle fibers as the[medical-dictionary.thefreedictionary.com]
  • Pro-inflammatory cytokines and chemokines have been implicated in the maintenance of sarcoidosis-associated inflammation.[clinicalpainadvisor.com]
Lymphadenopathy
  • The lymphadenopathy specimens were biopsied via mediastinoscopy, and histological study revealed noncaseating epithelioid granulomatous inflammation consistent with sarcoidosis.[ncbi.nlm.nih.gov]
  • Imaging: Chest radiograph (bihilar lymphadenopathy, infiltrates), high resolution computed tomography of the chest (intrathoracic lymphadenopathy, fibrosis), MRI plus gadolinium of heart or brain (for cardiac and neurological sarcoidosis), gallium-67[ptpaces.wordpress.com]
  • […] pulmonary infiltrates without lymphadenopathy.[rheumaknowledgy.com]
  • Skin lesions – more likely to have lymphadenopathy & hepatosplenomegaly than if no skin lesions. May portend prognosis.[slideshare.net]
  • A subject with type 1 diabetes complicated by peripheral and autonomic neuropathy presented cough and cervical lymphadenopathy. The chest computed tomography (CT) scan revealed bilateral hilar lymphadenopathy.[care.diabetesjournals.org]
Hodgkin Lymphoma
  • Sarcoid reactions are not exceptional and occur in 4.4% of carcinomas, 13.8% of patients with Hodgkin diseases, and in 7.3% of cases of non- Hodgkin lymphomas [ 2 ]. However, cases of sarcoid reactions associated with benign tumors are exceptional.[omicsonline.org]
  • "Occurrence of sarcoidosis subsequent to chemotherapy for non-Hodgkin's lymphoma: report of two cases". Annals of Hematology. 81 (2): 103–5. doi : 10.1007/s00277-001-0415-6. PMID 11907791.[en.wikipedia.org]
Weight Gain
  • IIH symptoms often start or worsen during a period of weight gain and resolve with 5-10% total weight loss. The disease is rare in thin men.[eyerounds.org]
  • Furthermore, their prolonged use often results in adverse effects such as Cushingoid features (buffalo hump, redistribution of body fat, purple striae and moon face), weight gain, hyperglycaemia, osteoporosis, hypertension, peptic ulcer, acne, insomnia[em-consulte.com]
Uremic Frost
  • Uremic frost Uremic frost is a rare dermatologic manifestation of severe azotemia. The characteristic white, crystalline, and friable deposits arising in the head and neck area.[bobbybukamd.com]
Stroke
  • Sarcoidosis should be considered in the differential diagnosis of stroke of unknown origin in any young patient, even in the absence of other clinical or laboratory features of sarcoidosis. Copyright 2012 National Stroke Association.[ncbi.nlm.nih.gov]
  • Neurosarcoidosis and stroke. Stroke 1990 ; 21 : 152 –53 Brown MM, Thompson AJ, Wedzicha JA, et al. Sarcoidosis presenting with stroke. Stroke 1989 ; 20 : 400 –05 Ketonen L, Oksanen V, Kuuliala I.[ajnr.org]
  • CT scans can reveal abnormalities in brain structure, including narrowed, overstretched or broken blood vessels and past strokes. Magnetic resonance imaging (MRI).[go2jo.com]
  • Stroke/TIA. Ear, nose and throat Salivary gland dysfunction. Nosebleeds, nasal obstruction. Others Lymphatic (evidence of hypersplenism). Sarcoidosis can be associated with increased incidence of lymphoma [ 1 ]. Hypercalcaemia. Nephrolithiasis.[patient.info]
  • Irving Memorial Hospital Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke[emedicine.medscape.com]
Dysarthria
  • This previously healthy 27-year-old man was admitted due to several daily episodes of usually left hemiparesis and dysarthria lasting between 15 seconds and 3 minutes. He did not respond to aggressive antithrombotic treatment.[ncbi.nlm.nih.gov]
  • On neurologic examination, the patient had dysarthria, mild aphasia, and right upper and lower extremity weakness without cranial neuropathy.[ajnr.org]
Slurred Speech
  • During this presentation, the patient experienced right leg paresthesias, slurred speech, right facial droop, and right upper and lower extremity weakness 2 hours after the first onset of symptoms.[ajnr.org]

Workup

  • This case highlights the importance of tissue diagnosis and the diagnostic workup for sarcoidosis in cases of cryptogenic hydrocephalus.[nnjournal.net]
  • She was diagnosed with idiopathic intracranial hypertension and referred to a neurologist for further workup and management. The neurologist performed a lumbar puncture which showed an elevated opening pressure of 50 cm H 2 O.[eyerounds.org]
  • Definitive diagnosis of neurosarcoidosis requires the exclusion of other causes of neuropathy and the identification of noncaseating sarcoid granulomas by histologic analysis of nerve and muscle biopsy specimens (see Workup).[emedicine.medscape.com]
  • "Sarcoidosis Workup". Medscape Reference. WebMD. Archived from the original on 1 March 2014. Retrieved 19 February 2014. Allmendinger A, Perone R (2009). "Case of the Month". Diagnostic Imaging. 31 (9): 10. Joanne Mambretti (2004).[en.wikipedia.org]
  • Foreign bodies in granulomatous cutaneous lesions and sarcoidosis are not mutually exclusive and, therefore, a workup to exclude systemic sarcoidosis should be undertaken [ 20, 25, 26, 27, 28, 29, 30, 31, 32 ].[em-consulte.com]
Granulomatous Tissue
  • Patient was subjected to FNAC thyroid which revealed ill-formed elements of granulomatous tissue. Patient refused to undergo the biopsy of the thyroid gland.[ijem.in]
  • tissue from patients with sarcoidosis. 6 The important targets of 1,25(OH) 2 -D 3 are the intestinal epithelium and bone, where the hormone acts to increase intestinal calcium and phosphate absorption, increase osteoclastic recruitment and bone resorption[academic.oup.com]
Liver Biopsy
  • ., Couzigou, P. and De Lédinghen, V. (2005) Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C.[scirp.org]
  • Some authors have recommended performing liver biopsy after each 1 to 1.5 grams of cumulative therapy (approximately every two years) [ 146 ]. Similar to antimalarials, relapse of sarcoidosis is common after the discontinuation of therapy.[em-consulte.com]

Treatment

  • Stay at the forefront of your field with updated treatment methods throughout, as well as an increased focus on patients with skin of color.[books.google.com]
  • He did not respond to aggressive antithrombotic treatment.[ncbi.nlm.nih.gov]
  • […] the 4-mg treatment group showed a significant increase compared with placebo ( P .012).[clinicalpainadvisor.com]
  • At this time, there is no consistently effective treatment for necrobiosis lipoidica. Treatment options include corticosteroids, fibrinolytics, antiplatelet agents, and surgical treatments (i.e. excision and grafting).[bobbybukamd.com]
  • A variety of treatments for IIH have been proposed and there is much anecdotal evidence for these treatments.[eyerounds.org]

Prognosis

  • Seite 117 - Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology 191 (3): 675-680 141. ‎[books.google.de]
  • May portend prognosis. Classified as: Specific (lesions contain granulomas) Non-specific (lesions are reactive processes and do not contain granulomas). 18.[slideshare.net]
  • They may be interpreted as a defense reaction against a tumor’s antigens, and may have a more favorable prognosis than classical malignant nodes.[omicsonline.org]
  • Early sarcoid arthritis is often self-limited, lasting for days to months, and the prognosis is excellent.[rheumaknowledgy.com]
  • Prognosis The prognosis of patients with sarcoidosis mainly depends on the extent and severity of the systemic involvement [ 15, 17, 18, 20 ].[em-consulte.com]

Etiology

  • A discussion of the etiology, diagnosis, systemic and ocular manifestations, and treatment of sarcoidosis is presented. Format: video Series: Moran Eye Center Grand Rounds Identifier: Moran_CORE_21552 Copyright statement: Copyright 2016.[morancore.utah.edu]
  • Etiology: Although exposure to an infectious organism or some other environmental agent has long been hypothesized to be etiologically relevant to the disease, none has been conclusively implicated.[rheumaknowledgy.com]
  • Etiology and Clinical Diagnosis The etiologies of microscopic hematuria are numerous and range from clinically insignificant causes to potentially life-threatening neoplastic lesions 5 ( Table 1 2, 3, 7 – 9 ).[aafp.org]
  • Etiology Despite multiple investigations, the cause of sarcoidosis remains unknown. Currently, the most likely etiology is an infectious or noninfectious environmental agent that triggers an inflammatory response in a genetically susceptible host.[what-when-how.com]
  • Sarcoidosis and juvenile idiopathic arthritis are both multisystem disorders with poorly understood etiologies. The diagnosis of juvenile idiopathic arthritis depends on the history, clinical features and radiological findings.[ijdvl.com]

Epidemiology

  • Gastroenterology, 127, S5-S16. [ 2 ] El-Serag, H.B. (2002) Hepatocellular carcinoma: An epidemiologic view.[scirp.org]
  • Epidemiology Exact prevalence (estimated at 10 to 20 per 100,000 population). Annual incidence of sarcoidosis are not known with certainty Incidence peaks in winter and early spring. Women greater incidence. African ethnicity greater incidence.[slideshare.net]
  • Epidemiology [ edit ] The prevalence of sarcoid is estimated to be 10 to 20 per 100,000 people.[en.wikibooks.org]
  • James DG, Hosoda Y: Epidemiology. In: James DG, ed. Sarcoidosis and other granulomatous disorders. New York, Marcel Dekker; 1994 :729–43 2. Stern BJ: Neurological complications of sarcoidosis. Curr Opin Neurol; 2004:17:311-6 3.[ispub.com]
  • "The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival" (PDF). American Journal of Epidemiology. 123 (5): 840–5. doi : 10.1093/oxfordjournals.aje.a114313. PMID 3962966.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Posterior reversible encephalopathy syndrome, part 2: Controversies surrounding pathophysiology of vasogenic edema. Am J Neuroradiol 2008;29:1043-9. [ PUBMED ] [ FULLTEXT ] 7. Saigal G, Bhatia R, Bhatia S, Wakhloo AK.[annalsofian.org]
  • ARA 290 relieves pathophysiological pain by targeting TRPV1 channel: Integration between immune system and nociception. Peptides. 2016;76:73-79. doi: 10.1016/j.peptides.2016.01.003 Heij L, Niesters M, Swartjes M, et al.[clinicalpainadvisor.com]
  • Pathophysiology [ edit ] The diagnosis of sarcoid is based on compatible clinical and radiographic findings, supportive laboratory data (elevated ACE levels, anergy, elevated serum gamma globulins, positive Kveim test), and evidence of noncaseating granulomas[en.wikibooks.org]
  • Pathophysiology and Immunopathogenesis The granuloma is the pathologic hallmark of sarcoidosis. A distinct feature of sarcoidosis is the local accumulation of inflammatory cells.[what-when-how.com]
  • Pathophysiology In IIH, there is no structural obstruction to the circulation of CSF.[eyerounds.org]

Prevention

  • Reducing Risk & Slowing Down the Disease Sarcoidosis can’t currently be cured, but it can be managed to prevent other problems, such as heart failure, from developing over time.[heart.templehealth.org]
  • Major goal : prevent fibrosis. Steroids first line : Help prevent fibrosis. Scarring cutaneous lesions Hypercalcemia Severe lung disease Liver disease Cardiac inflammation Posterior uveitis Neurosarcoidosis Severe sarcoidosis of other organs 46.[slideshare.net]
  • Prevention Although sarcoidosis cannot be prevented, some preventative measures may reduce complications. For example: Influenza vaccination. Osteoporosis prophylaxis (steroid usage).[patient.info]
  • Although primary prevention studies suggest that cholecalciferol is not entirely effective in preventing glucocorticoid-induced bone loss, 16 it is well tolerated by patients, and can be used once hypercalcaemia has been excluded.[academic.oup.com]
  • Prevention Prevention Because the cause of transient global amnesia is unknown and the rate of recurrence is low, no standard approaches for preventing the condition exist.[go2jo.com]

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