1/20. Pediatric sarcoidosis in india.OBJECTIVE: Since 1957, when the first pediatric case of sarcoidosis was reported, 11 more cases have been traced in the Indian literature. methods: Nine of them were reported from general wards of hospitals (while the remaining 3 were from pediatric unit of AIIMS, New Delhi). Failure of initial treatment with anti-tuberculosis drugs for some months, necessitated search for an alternative diagnosis. Considerable delay (several months to years) occurred due to several parent- or physician-dependant factors. RESULTS: Affection more in girls (9 to 12), universal fever and constitutional symptoms, loss of weight, scanty lung features, hepatomegaly, often with massive splenomegaly, frequent lymphadenopathy etc. caused initial confusion. CONCLUSION: Treatment with oral steroid or with chloquine and NSAIDS with or without steroid MDI gave equally good results. Long follow-up was done in a few cases only, showing relapses in nearly 66%. One case had a superinfection with acid-fast bacilli.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/20. Reactivation of sarcoidosis during interferon therapy.The exacerbation of a co-existing autoimmune disease is often a concern for physicians who use immunomodulating agents for the treatment of a concomitant process. As physicians begin to treat chronic hepatitis c more often and more aggressively, this potential problem with occur more frequently. Herein we reported a case of reactivation of sarcoidosis occurring during the treatment of chronic hepatitis c, and we present a literature review of other centers' experiences with this problem. Depending upon the severity of the exacerbation and the type of organ involvement, reactivation of sarcoidosis may require discontinuation of the interferon therapy, with or without the use of additional steroids. The majority of patients, however, do not require the use of steroids. Interestingly, continuation of the interferon therapy in the presence of a mild-to-moderate exacerbation of sarcoidosis may be safe in a minority of patients with noncritical organ involvement.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/20. Nasal sarcoidosis.Nasal sarcoidosis may affect nasal skin, mucosa, or bone separately or simulataneously. Its incidence in patients with systemic sarcoid was once thought to be low, but this may be due to lack of proper intranasal examination and awareness of its existence by physicians who are more preoccupied with lung and other visceral involvement. The otolaryngologist should be aware of nasal sarcoidosis because nasal obstruction or drainage secondary to nasal sarcoidosis may be the first and only manifestation of systemic sarcoidosis. The otolaryngologist can diagnose this disease earlier in its course by being aware of its existence.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/20. Detection of covert myocardial sarcoidosis by scalene node biopsy.The antemortem diagnosis of myocardial sarcoidosis is rare in patients without overt signs of the disease. Two patients are presented to alert physicians to the value of early scalene node biopsy when sarcoidosis could be the cause of marked disturbances in cardiac conduction. The first patient, aged 29 years, had first, second, and third degree atrioventricular block and intermittent left and right bundle-branch block; the second, aged 59 years, had second degree atrioventricular block and complete right bundle-branch block. Both had diagnoses of sarcoidosis based on scalene node biopsy. The cardiac conductive disturbance improved, and the symptoms disappeared with steroid therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/20. Refractory sarcoidosis responding to infliximab.Despite aggressive treatment with conventional therapy, sarcoidosis may be progressive and debilitating. Tumor necrosis factor (TNF)-alpha is critical in the genesis and maintenance of granulomatous inflammation. Agents developed to inhibit TNF-alpha have been approved to treat rheumatoid arthritis and inflammatory bowel disease with unprecedented success. As such, physicians are increasingly using these agents to treat patients with other inflammatory diseases, including sarcoidosis. We report a case of refractory sarcoidosis, involving the lung, eyes, skin, and heart, which flared despite aggressive therapy. Oculocutaneous sarcoid dramatically improved after treatment with the anti-TNF antibody infliximab.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/20. Case report: bilateral ankle pain in an aerobic dancer.A 32-yr-old female presented to Sports Clinic with bilateral ankle pain and swelling following the initiation of an aerobic dance program 3 months earlier. Physical exam revealed bilateral ankle edema and the recent appearance of discrete tender nodules on her anterior tibias, consistent with erythema nodosum (EN). As part of her evaluation, chest radiographs were performed and demonstrated bilateral hilar adenopathy. This case discusses the evaluation of the patient with joint involvement, EN, and hilar adenopathy. The increased accessibility of sports medicine clinics makes it incumbent on the physician to be familiar with a wide range of differential diagnoses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/20. sarcoidosis or Sjogren syndrome? Clues to defining mimicry or coexistence in 59 cases.We present 5 new cases of coexisting sarcoidosis and Sjogren syndrome (SS) and review the literature for additional cases in order to analyze the clinical, immunologic, and histologic characteristics that may help physicians differentiate the mimicry of SS by sarcoidosis from a true coexistence of both autoimmune diseases. We considered the coexistence of sarcoidosis with SS to be when patients presented specific histologic patterns of both diseases, simultaneously or at different times.Fifty-nine patients were included in the analysis (54 identified in the literature search plus our 5 unpublished cases): 49 (83%) patients were female and 10 (17%) were male, with a mean age at diagnosis of 50 years. According to the histopathologic examination of the exocrine glands performed in 53 cases, we defined coexistence of sarcoidosis and SS in 28 cases, while in the remaining 25 patients, sarcoidosis mimicked SS. Clues to identifying when sarcoidosis coexists with SS were a higher prevalence of systemic manifestations (arthritis and uveitis) and positive immunologic parameters (antinuclear antibodies, rheumatoid factor, and anti-Ro/SS-A), as well as the existence of a focal sialadenitis (Chisholm-Mason score grades III-IV, with a CD4 lymphocytic infiltration) in the salivary gland biopsy. In patients first diagnosed with primary SS, the appearance of some clinical features such as hilar adenopathies, uveitis, or hypercalcemia leads to the diagnosis of coexisting sarcoidosis. A careful application of the new American-European consensus criteria had a sensitivity of 93% and a specificity of 92% in identifying when SS coexists with sarcoidosis.In conclusion, the association of sarcoidosis with SS leads to a true coexistence of both diseases in more than half the patients described in the literature, while in the remaining patients, sarcoidosis mimics SS. In light of these results, sarcoidosis should not be considered as an exclusion criterion for the diagnosis of SS, and in patients with a suspected overlap of the two diseases, application of the new American-European consensus criteria for diagnosis of SS should be mandatory.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/20. sarcoidosis with gingival involvement: a case report.BACKGROUND: The case outlined is a rare presentation of sarcoidosis intraorally associated with gingival ulceration. methods: The diagnosis was made following a gingival biopsy. RESULTS: The patient was subsequently referred to a physician for clinical management and the condition resolved without active treatment. CONCLUSIONS: sarcoidosis should be considered in the differential diagnosis of persistent swellings and ulceration of the oral mucosa. Intraoral sarcoid lesions are often the first indication of systemic involvement. It is important to make the diagnosis and monitor the condition as sarcoidosis is progressive if untreated in a small number of those affected.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/20. Mid-line swelling of the palate.sarcoidosis is a multi-system, non-caseating granulomatous disease of unknown aetiology that may affect any organ. The oral involvement of sarcoidosis is rare and usually an initial manifestation of the disease. In this case report the authors present a 25-year-old African-American woman with palatal sarcoidosis treated successfully with intra-lesional corticosteroid injections. The oral manifestations of sarcoidosis are relatively uncommon and may be the only manifestation of the disease. Suspected cases of oral sarcoidosis should be biopsied and subsequently referred to a physician to rule out systemic involvement.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/20. The unique complications of coccidioidomycosis of the spine: a detailed time line of disease progression and suppression.STUDY DESIGN: A case report is presented. OBJECTIVE: We report a detailed time-line of disease progression and suppression in a patient with disseminated coccidioidomycosis of the spine. The importance of consistent and thorough treatment to prevent disease recurrence is underscored. SUMMARY OF BACKGROUND DATA: coccidioides immitis is a dimorphic fungus that lives as a saprophyte in arid, alkaline soils and as a parasite in the tissues of its host. Endemic to the arid soil of the American Southwest and Central and south america, its disease prevalence is increasing. There are 100,000 new infections diagnosed each year, of which 34% are symptomatic. Of the symptomatic individuals 5-10% will develop a serious pulmonary infection and of those that have a serious infection less than 1% will develop chronic pulmonary disease and/or extrapulmonary dissemination. methods: A 36-year-old black woman with a 3-year history of recent migration to the desert Southwest and a family history of sarcoidosis presented to her primary care physician with shortness of breath and a cough of 2 months' duration. An anterior-posterior radiograph revealed bilateral hilar lymphadenopathy and sarcoidosis was diagnosed. The patient was placed on oral prednisone and progressively worsened. She was referred to the Orthopedic Clinic with a complaint of severe back pain. RESULTS: Plain radiographs of the lumbar spine revealed lytic erosion of the sacral promontory. Computed tomography confirmed the sacral lesion in addition to revealing involvement of the fifth lumbar vertebral body. Over the ensuing years the patient underwent a course of operative and chemotherapeutic therapies. She endured numerous complications of the disease, one of which is being reported for the first time. Control of her disease has been accomplished through radical surgical debridement, spinal stabilization with concomitant local and systemic chemotherapy. CONCLUSIONS: The prevalence and distribution of coccidioidomycosis is increasing as is the likelihood of seeing its often unique and bizarre clinical manifestations and complications. If included in the differential diagnosis, the disease can be recognized earlier and the likelihood of numerous complications can be avoided. Once bony involvement is diagnosed a regimen of aggressive surgical debridement as well as consistent chemotherapy must be employed if remission and/or eradication of the illness are sought.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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