Contribution of Imagery in the Diagnosis of Multisystemic Sarcoidosis in the Service Radiology Department of the Mother and Child Hospital “Le Luxembourg” in Bamako: A Case Report

The aim of this study was to report a case of multi-visceral sarcoidosis at the Mother-Child Hospital Center (CHME) “Le Luxembourg” in Bamako, Mali. Observation: This is a patient aged 62 at the time of consultation, a housewife, residing in the Banconi district, who was referred to us for thoracic-abdominopelvic imaging for chronic liver disease. After several diagnostic errors, the thoracic-abdominopelvic CT scan and liver MRI performed in our center showed, at the thoracoabdominal level, bilateral diffuse pulmonary micronodules and bilateral mediastinal-hilar lymphadenopathy;on the abdominal level, a dysmorphic liver with plaques of steatosis and a granular appearance of the liver parenchyma without periportal fibrosis. These imaging data combined with those from the liver nodule biopsy and biology confirmed the diagnosis of sarcoidosis type II. Treatment with corticosteroids gave satisfactory results and the patient recovered after 18 months. Clinical and CT monitoring 2 years from the start of the disease and 2 months from the end of treatment showed complete resolution of the lesions. Conclusion: The multi-visceral location of sarcoidosis is an entity whose diagnosis remains difficult;diagnostic and interventional imaging has an important place in its management.

Pulmonary sarcoidosis:A novel sequelae of drug reaction with eosinophilia and systemic symptoms:A case report

BACKGROUND Drug reaction with eosinophilia and systemic symptoms(DRESS)syndrome is an uncommon yet serious adverse drug hypersensitivity reaction with the presentations including rash,fever,lymphadenopathy,and internal organ involvement.Sarcoidosis is a systematic granulomatous disease with unknown etiology.We herein report a case of pulmonary sarcoidosis secondary to allopurinol-induced DRESS.CASE SUMMARY A 37-year-old man with a history of hyperuricemia was treated with allopurinol for three weeks at a total dose of 7000 milligrams before developing symptoms including anorexia,fever,erythematous rash,and elevated transaminase.The patient was diagnosed with DRESS and was treated with prednisone for 6 mo until all the symptoms completely resolved.Three months later,the patient presented again because of a progressively worsening dry cough.His chest computed tomography images showed bilateral lung parenchyma involvement with lymph node enlargement,which was confirmed to be nonnecrotizing granuloma by pathological examination.Based on radiologic and pathological findings,he was diagnosed with sarcoidosis and was restarted on treatment with prednisone,which was continued for another 6 mo.Reexamination of chest imaging revealed complete resolution of parenchymal lung lesions and a significant reduction in the size of the mediastinal and hilar lymph nodes.Following a 6-month follow-up of completion of treatment,the patient's clinical condition remained stable with no clinical evidence of relapse.CONCLUSION This is the first case in which pulmonary sarcoidosis developed as a late complication of allopurinol-induced DRESS.The case indicated that the autoimmune reaction of DRESS may play an important role in the pathogenesis of sarcoidosis.

Extrapulmonary sarcoidosis of liver and pancreas: A case report and review of literature

Sarcoidosis is a chronic multisystemic granulomatous disease of unknown origin, which can involve nearly all organs. In the case of an infrequent gastrointestinal tract involvement in systemic sarcoidosis, granulomas of the liver are most commonly described while isolated pancreatic sarcoid lesions are rarely seen. We report a case of systemic sarcoidosis with exclusive extrapulmonal involvement of the liver and the pancreas in a 71-year- old white man. The diagnosis of liver involvement was confirmed by biopsy. Pancreatic surgery was needed because preoperative evaluation could not exclude pancreatic cancer and for biliary decompression. An extensive literature review of systemic sarcoidosis, focusing on reported cases with unusual presentation of sarcoidosis in the liver and the pancreas, its diagnosis, treatment, and prognosis was made.

Unusual isolated extrapulmonary sarcoidosis: Case report

Sarcoidosis is a granulomatous condition with unidentified etiology. This disease should be considered in differential diagnosis if non-caseating granulomas is noted in biopsies, because numerous cases presented with no clinical symptoms. Although the lung is the most common organ involved in the disease, there also is an extra-pulmonary form (<10%). It should be noted that the presentation of sarcoidosis may be atypical. In this article, we report a systemic sarcoidosis case, with specific clinical findings: extrathoracic onset with lymph nodes.

Pulmonary <i>Aspergillus fumigatus</i>and <i>Cryptococcus neoformans</i>Co-Infection on an Underlying Sarcoidosis Condition: Report of a Rare Case

Sarcoidosis is a systemic granulomatosis from an unknown etiology, particularly affecting the lungs and the lymphatic system. It is associated with an immune deficiency involving an excessive immune response mediated by TH1 lymphocytes. Its evolution can lead to serious complications such as pulmonary fibrosis, pulmonary hypertension, bronchial stenosis and opportunistic infections. Opportunistic infections rarely occur on an underlying sarcoidosis condition. We report a rare case of pulmonary aspergillary and cryptococcal co-infection, on a patient with sarcoidosis who was finally lost to follow up. It was about a 47 years old female patient, diagnosed in 2015 for mediastino-pulmonary and neurological sarcoidosis. She was in therapeutical rupture after a 3-month period of corticotherapy at a dosage of 20 mg daily. The patient has been lost of sight for 3 years and was seen again on November, 22nd, 2018 at the Internal Medicine/Rheumatology Department of DALAL JAMM Hospital. At his admission she presented: a low grade hemoptysia, a chronic cough, a shortness of breath on exertion CRD Stage 2. At the biological investigation, the CRP was at 71.9 mg/l. Calcium serum levels were at 102.6 mg/l. Sputum culture and AFBS were negative. The screening serology of aspergillary Ig G was positive at 12.4 UA/ml. Thoracic High Resonance CT pointed suggests a Stage 2 Sarcoidosis complicated with aspergillary graft. The bronchoscopy showed out a severe suppurated bronchopathy. Microscopic examination of the BAF found some Cryptococcus neoformans settlement. We concluded a diagnosis of pulmonary aspergilloma and cryptococcosis co-infection with an underlying condition of Stage 2 Sarcoidosis. We successfully treated our patient with an oral intake of Itraconazole at a dosage of 400 mg daily over a period of 10 days. This is a rare and life-threatening triple association. In our case, the patient was lost to follow up for a long period and this was considered as the first morbidity risk factor.

Echocardiographic Measurement of Pulmonary Arterial Pressure in Patients with Sarcoidosis

Introduction: Pulmonary hypertension (PH) is a significant complication and is poor prognostic factor for sarcoidosis. We evaluated various tests of diagnosis and treatment as well as the associations between PH and value of six-minute walk test (6 MWT) in sarcoidosis patients. Methods: This study was conducted with fifty patients with sarcoidosis. We grouped patients according to echocardiography. Results: PH prevalence in sarcoidosis was found to be 10%. In cases with likely PH, FEV1%, FVC%, MMF% was found to be lower. Although DLCO was less than 80% in the group of likely PH and over 80% in the other, there were no statistical differences between two groups. Mean value of FVC/DLCO ratio was 1.1 ± 0.38 in group of likely PH. There was no significant difference between groups. Mean distance of 6 MWT was 464 ± 105 m in all cases. There were no statistical differences between two groups in 6 MWT. Significant desaturation with exercise was observed in cases with PH (p = 0.007). Conclusion: In all stages, patients who have longer disease duration and abnormal pulmonary function tests, should be examined about PH. Patients should undergo 6 MWT and presence of desaturation after 6 MWT, even without hypoxemia, should be looked after and dealt with accordingly.

Research Progress of Pulmonary Sarcoidosis in Traditional Chinese Medicine and Western Medicine

Objective:To summarize the current treatments of traditional Chinese medicine and Western medicine and to explore ideas for clinical treatments,rational use of traditional Chinese medicine,avoid medication errors,and make full use of the respective advantages of traditional Chinese medicine and Western medicine to achieve good results.Methods:We selected recent articles on pulmonary sarcoidosis and clinical observation at home and abroad,and summarized relevant traditional Chinese medicine books.Results:At present,hormone therapy is preferred in western medicine,followed by antimetabolic drugs,Anti-TNF,and also potential drug therapeutic strategies,such as"CLEAR"regimen and new target therapy.Traditional Chinese medicine through syndrome differentiation,from the whole,flexible use of dispel evil,phlegm,blood circulation,dredging collaterals,qi and other methods to achieve the effect of dissolution.Conclusion:The treatment research results of pulmonary sarcoidosis are considerable,but there are still many risk factors in Western medicine,and the benefits and treatment indications of individual drugs are still under study.Traditional Chinese medicine has certain safety and efficacy in the prevention and treatment of pulmonary sarcoidosis,but it needs modern medical technology examination.Therefore,the advantages of traditional Chinese and Western medicine should be fully combined to achieve the maximum treatment effects.

Iatrogenic flexor tendon rupture caused by misdiagnosing sarcoidosis-related flexor tendon contracture as tenosynovitis: A case report

BACKGROUND Sarcoidosis is a multisystem disease characterized by granuloma formation in various organs.Sarcoidosis-related flexor tendon contractures are uncommon in clinical settings.This contracture is similar to stenosing tenosynovitis and po-tentially leads to misdiagnosis and mistreatment.Herein,we report a rare case of sarcoidosis-related finger flexor tendon contracture that was misdiagnosed as tenosynovitis.A 44-year-old woman presented to our department with flexion contracture of the right ring and middle fingers.The patient was misdiagnosed with tenosynovitis and underwent acupotomy release of the A1 pulley of the middle finger in an-other hospital that resulted in iatrogenic rupture of both the superficial and profundus flexors.Radiological presentation showed multiple sarcoid involve-ments in the pulmonary locations and ipsilateral forearm.A diagnosis of sar-coidosis was made based on the presence of non-caseating granulomas with tubercles consisting of Langhans giant cells with lymphocyte infiltration on biopsy,and the patient underwent surgical repair for the contracture.After 2 mo,the patient experienced another spontaneous rupture of the repaired middle finger tendon and underwent surgical re-repair.Satisfactory results were achieved at the 10 mo follow-up after reoperation.CONCLUSION Sarcoidosis-related finger contractures are rare;thus,caution should be exercised when dealing with such patients to avoid incorrect treatment.

Renal Involvement in Sarcoidosis

Introduction: Sarcoidosis is a granulomatous systemic disease. Renal damage is rare but it can evolve to chronic renal failure (CRF). The aim of our work is to describe the clinical, paraclinical, histological and evolutionary profile of renal involvement during sarcoidosis and to identify the progression factors leading to CRF. Materials and Methods: This is a retrospective descriptive study from January 2009 to December 2022. We collected the medical records of patients with sarcoidosis and renal involvement. To study the progression factors leading to CRF we identified two groups of patients: the group with normal renal function and the group that developed CRF. Results: We included in our study 17 patients with renal sarcoidosis. Their mean age was 45 ± 14.7 years and the sex ratio was 0.4. Renal involvement is revealing of sarcoidosis in 76% of cases. Renal failure was diagnosed in 88% of patients. Proteinuria was positive in 76.5% of cases, leukocyturia in 59% of patients and hematuria in 41% of patients. Renal biopsy was performed in 15 patients showing tubulointerstitial nephropathy in all biopsies. Epithelioid and gigan-to-cellular granuloma without caseous necrosis was found in 46% of cases. Associated glomerular involvement such as segmental and focal hyalinosis was found in 2 patients. Corticosteroid therapy was initiated in 88% of patients for a median duration of 15 months. Normalization of renal function was achieved in 41% of patients, while 59%, i.e. 10 patients, retained a CRF, including 2 who were on dialysis. We showed a statistically significant relationship between the evolution towards CRF and the presence of interstitial fibrosis > 25%. Conclusion: Despite its rarity, renal involvement can be revealing of sarcoidosis, which can condition the prognosis and lead to CRF. Its detection allows an early diagnosis and treatment.

Unusual presentation of multiorgan extrapulmonary sarcoidosis

To the Editor,Sarcoidosis is a disease known for over a century and remains enigmatic in etiology and pathophysiology.1 While the pulmonary manifestation prevails in more than 90%of cases,sarcoidosis can affect any organ.Commonly,it targets the eyes,skin,lymph nodes,and,in rare instances,the liver and spleen.2 The development of the disease is significantly influenced by genetic and environmental factors,as well as gene variations on chromosome 6.Notably,first-degree relatives of patients have a heightened risk factor of 3.7.Other adverse prognostic factors involve being of Black race,female gender,and having a lower income.The increased incidence of sarcoidosis among firefighters who responded to the 9/11 disaster highlighted environmental triggers,including agricultural employment,metalworking,firefighting,exposure to inorganic and silica dust,and handling building supplies.1 Clinical symptoms can vary widely depending on the affected organ.Diagnosis often relies on characteristic chest radiography findings,but approximately 10%of patients show noncaseating granulomas on biopsy without pulmonary abnormalities.2 Herein,we present a unique case of multiorgan sarcoidosis,where the sole manifestations were severe thrombocytopenia,weight loss,and a history of cerebral vascular events.

Neurosarcoidosis: An Illustrative Case and Review of Perioperative Considerations

Sarcoidosis is a multisystem inflammatory granulomatous disease of unknown etiology. Neurosarcoidosis (NS) is a rare but potentially devastating manifestation of sarcoidosis, with a prevalence of approximately 5% in patients with systemic sarcoidosis. Due to the possible involvement of any part of the nervous system, a myriad of neurological manifestations can occur. Clinical features resulting from involvement of the hypothalmo-pituitary axis and cranial nerves, in particular, cranial nerve VII are the more common presentations of this condition. Medical therapy with corticosteroids is the mainstay of treatment and providing tissue for diagnosis remains the principal indication for surgery. Therapeutically, neurosurgery is indicated only for life-threatening complications. We describe the clinical case of a patient with fatally progressive NS who had multiple anesthetic exposures. This case highlights the perioperative considerations of NS and its anesthetic implications.

The Role of Gallium (Ga-67) Scintigraphy in the Diagnosis of Sarcoidosis

Purpose: To identify and interrogate the role of Gallium-67 scintigraphy in the diagnosis of Sarcoidosis. Methods: A retrospective study of 75 patients with suspected Sarcoidosis in a large teaching hospital with a specialist Sarcoidosis Centre. Results: Ga-67 scintigraphy in patients considered on clinical grounds to have Sarcoidosis is a useful and sensitive test, and furthermore, by relaxing the interpretation of gallium scintigraphy sensitivity may be increased (from 20% to 80%) for a relatively small drop in specificity. Conclusions: The sensitivity of diagnostic power may be increased with a change in diagnostic criteria at the expense of only a small drop in specificity. In the context of Neurosarcoidosis, our results support the theory that Ga-67 scintigraphy has value in identifying potential, asymptomatic biopsy sites outside of the CNS that may not be identified by other forms of imaging.

Exercise-induced torsades de pointes as an unusual presentation of cardiac sarcoidosis: A case report and review of literature

BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected organ.While cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis cases,it is still underdiagnosed and is associated with a poor prognosis.Although the etiology of sarcoidosis remains unclear,an antigen triggered exaggerated immune response has been hypothesized.Early detection and prompt management of cardiac sarcoidosis remains pivotal.CASE SUMMARY A 60-year-old female,with pulmonary sarcoidosis in remission,presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion(New York Heart Association class II)that was relieved by rest.Submaximal exercise stress test showed multifocal ventricular extrasystoles,followed by a self-limiting torsades de pointes.Cardiac magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal dyskinesis.The magnetic resonance imaging-derived left ventricular ejection fraction was 45%.Delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles,all in favor of extensive cardiac involvement of sarcoidosis.A double-chamber implantable cardiac defibrillator was implanted,and methylprednisolone(12 mg/d)and methotrexate(12.5 mg/wk)treatment was initiated.Follow-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing run.CONCLUSION Along an extensive review of the literature,this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis,in order to avoid potential complications and increase survival.

Cranial neuropathies in sarcoidosis

Sarcoidosis is a multisystem, chronic inflammatory disease that is characterized by the development of non-caseating granulomas in multiple body tissues and organ systems. Neurological complications of systemic sarcoidosis include peripheral and cranial neuropathies, myopathies, seizures, gait dysfunction, and cognitive decline. Because sarcoidosis has a predilection to involve the basilar meninges, cranial neuropathy is the most prevalent neurological deficit seen when the nervous system is involved. Sarcoidosis cranial neuropathy may occur at different stages of the disease and even as the initial clinical manifestation of central nervous system involvement. Attributing a cranial neuropathy to sarcoidosis can be challenging, particularly in the setting of normal imaging studies. In this review, cranial neuropathies in sarcoidosis are discussed in detail.

Gastrointestinal sarcoidosis associated with pneumatosis cystoides intestinalis

A 39-year-old male reported fevers,weight loss,watery loose stools,and decreased visual acuity in his right eye over the prior five years.He was pancytopenic,had an elevated American council on exercise level,total bilirubin,and alkaline phosphatase.Computed tomography revealed massive hepatosplenomegaly and emphysematous lung changes.Liver biopsy showed non caseating granulomas.The patient was diagnosed with extrapulmonary sarcoidosis and was treated with prednisone.The patient symptomatically improved but 5 mo later presented with abdominal pain caused by perforation of the cecum.He underwent a cecectomy and pathology revealed pneumatosis cystoides intestinalis.This represents the first reported association between pneumatosis cystoides intestinalis and sarcoidosis.The etiology of pneumatosis cystoides intestinalis in this case was likely multifactorial and involved both effects of the corticosteroids as well as the advanced nature of the gastrointestinal sarcoidosis.Furthermore this case has the unique features of emphysematous lung changes and pancytopenia which are uncommon with sarcoidosis.

Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature

BACKGROUND Sarcoidosis is a granulomatous disease of unknown etiology that most often impacts the lungs.Cutaneous manifestations of sarcoidosis are seen among 9%- 37% of patients.Subcutaneous sarcoidosis is a rare presentation of cutaneous sarcoidosis with estimates of frequency ranging from 1.4%-16%.To date,very few articles and case reports have been written about this subject.In this paper,we describe a case of subcutaneous sarcoidosis and perform a review of the literature to determine if there are commonalities among patients who present with subcutaneous sarcoidosis.CASE SUMMARY A 38-year-old female,with a past medical history of arthritis and recurrent nephrolithiasis,presents with an 8-mo history of 4 firm,asymptomatic,skincolored nodules on her left and right upper extremities and neck.Needle biopsy and post-excisional pathology report both revealed well-formed,dense,noncaseating granulomas localized to the subcutaneous tissue.Chest computed tomography revealed mild mediastinal lymphadenopathy.A diagnosis of subcutaneous sarcoidosis was made,and the lesions were surgically removed.CONCLUSION Commonalities among patients presenting with subcutaneous sarcoidosis include: middle-aged female,lesions localizing to the upper or lower limbs,lymphadenopathy or pulmonary infiltration on chest imaging,elevated serum angiotensin-converting enzyme.

Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy

Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative,and patients with cardiac sarcoidosis(CS) who have impaired left ventricular(LV) systolic function are sometimes diagnosed with dilated cardiomyopathy(DCM).Late gadolinium enhancement(LE) in magnetic resonance imaging is now a critical finding in diagnosing CS,and the novel Japanese guideline considers myocardial LE to be a major criterion of CS.This article describes the value of LE in patients with CS who have impaired LV systolic function,particularly the diagnostic and clinical significance of LE distribution in comparison with DCM.LE existed at all LV segments and myocardial layers in patients with CS,whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM.Transmural(nodular),circumferential,and subepicardial and subendocardial LE distribution were highly specific in patients with CS,whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM.Since sarcoidosis patients with LE have higher incidences of heart failure symptoms,ventricular tachyarrhythmia and sudden cardiac death,the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.

Ultrasound imaging of abdominal sarcoidosis: State of the art

Since it has been recognized that sarcoidosis(SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for the diagnosis of the single organ involvement, and the concept has been reinforced that the exclusion of alternative causes is important to achieve the correct diagnosis. Ultrasound(US)is a useful tool to evaluate patients with suspected abdominal SA, such as of the liver, spleen, kidney, pancreas and other organs, showing findings such as organomegaly, focal lesions and lymphadenopathy. While the diagnosis of abdominal SA is more predictable in the case of involvement of other organs(e.g.,lungs), the problem is more complex in the case of isolated abdominal SA. The recent use of contrast-enhanced ultrasound and endoscopic ultrasound elastography has provided additional information about the enhancement patterns and tissue rigidity in abdominal SA. Here we critically review the role of US in abdominal SA, reporting typical findings and limitations of current evidence and by discussing future perspectives of study.

Sarcoidosis imitating breast cancer metastasis:a case report and literature review

Sarcoidosis is a benign systematic granulomatous disorder of unknown etiology and is associated with various malignancies.However, granulomatous and metastatic lymph node lesions are difficult to distinguish even when using precise and modern diagnostic methods, such as positron emission tomography. Thus, histological verification is the only method that can be used to accurately describe the nature of this disease. In this article, we report a case of non-luminal HER-2/neu-positive breast cancer in a patient without history of sarcoidosis and suspected to have metastatic disease.

Ductopenia related liver sarcoidosis

Sarcoidosis is a systemic granulomatous disease which may involve many organs.In approximately 95% of patients there is liver involvement,with noncaseating hepatic granulomas occurring in 21 to 99% of patients with sarcoidosis.Liver involvement is usually asymptomatic and limited to mild to moderate abnormalities in liver biochemistry.The occurrence of jaundice in sarcoidosis is rare;extensive imaging procedures and the examination of liver biopsies permit a precise diagnostic.Ductopenia associated with sarcoidosis has been reported in less than 20 cases and can lead to biliary cirrhosis and liver-related death.We report here on a case of ductopenia-related sarcoidosis in which primary biliary cirrhosis and extrahepatic cholestasis have been carefully excluded.The patient follow up was 8 years.Although ursodesoxycholic acid appears to improve liver biochemistry it does not preclude the rapid occurrence of extensive fibrosis.A review of the literature of reported cases of ductopenia related to sarcoidosis is provided.