ReviewSarcoidosis: Challenging Diagnostic Aspects of an Old Disease
Section snippets
Clinical Case 1
A 58-year-old man, a lifelong nonsmoker, had been previously diagnosed with sarcoidosis (based on transbronchial biopsies showing epithelioid non-necrotizing granulomas and compatible clinicoradiologic features) and successfully treated with oral steroids for 6 months (Figure 1). At that time, tuberculin skin test was negative. Nine years later he presented with 3 months history of night fever (up to 39°C), abdominal pain (left upper quadrant), fatigue, and weight loss. The patient was referred
Clinical Case 2
A 76-year-old woman, a lifelong nonsmoker, presented to our chest clinic with persistent high fever (up to 40°C). She had been diagnosed 12 months earlier with a cutaneous diffuse follicular lymphoma, which did not require any systemic treatment. Chest radiograph and computed tomography (CT) scan showed multiple enlarged mediastinal and hilar lymph nodes (Figure 3A). She underwent bronchoscopy with BAL, which revealed mild lymphocytosis (18%) with a normal CD4/CD8 ratio, and multiple
Concluding Remarks
The diagnosis of sarcoidosis requires the presence of a compatible clinical/radiographic picture, histologic evidence of noncaseating granulomas, and exclusion of known causes of granulomatous inflammation. Sarcoid granulomas can occur with varying rates in any organ system, but are most commonly found in the lungs and lymph nodes. Patients may be entirely asymptomatic and the condition discovered by the presence of characteristic findings on routine health screening chest radiographs (30%-60%
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Cited by (39)
Should we look for neoplasia in a patient with unexplained granulomatosis?
2019, Revue de Medecine InterneNoncaseating granulomatous diseases in germ cell cancer patients–A single-center experience
2019, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Especially for patients with testicular GCT increased coexistence of granulomatous diseases is reported [28–32,34]. Whether the development of SLL has a prognostic impact, still remains unclear [38]. As the first step in the diagnostic work-up of SLL/sarcoidosis, flexible bronchoscopy is recommended for the exploration of suspicious lymph nodes.
Imaging in Gastroenterology
2018, Imaging in GastroenterologyEvidence for M2 macrophages in granulomas from pulmonary sarcoidosis: A new aspect of macrophage heterogeneity
2018, Human ImmunologyCitation Excerpt :In addition, the CD4+/CD8 + ratio and the distribution of other macrophage subset markers (CD14 and CD68) were not different between the two diseases. Granuloma formation in sarcoidosis is believed to result from an immunologic response to a persistent or poorly degradable antigen by multiple immune cells over a period of days to weeks [39–41]. This immunogenic amplification can be associated with either Th1 or Th2 cells [31,42].
Juxta-vertebral lesions in granulomatosis with polyangiitis
2016, Seminars in Arthritis and RheumatismCitation Excerpt :Indeed, non-diagnostic biopsies from juxta-vertebral masses are not infrequent because of the exiguity of the specimen or because of sampling errors. Nevertheless, our opinion is that histological evaluation should be reserved for challenging cases, and should be primarily aimed to exclude malignant or infectious conditions [9,13–16]. Surgical procedures for diagnostic purposes should also weight the benefits against the risks of procedural complications due to the particular anatomical site.
Löfgren syndrome: A study of 80 cases
2014, Medicina Clinica
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Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.