Sarcoidosis beyond pulmonary involvement: A case series of unusual presentations.
| Title: | Sarcoidosis beyond pulmonary involvement: A case series of unusual presentations. |
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| Authors: | Medhat BM; Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Behiry ME; Rheumatology Unit. Internal Medicine Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Armed Forces College of Medicine (AFCM), Cairo, Egypt.; Fateen M; Clinical and Chemical Pathology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; El-Ghobashy N; Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Fouda R; Clinical and Chemical Pathology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Embaby A; Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Seif EM; Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Taha MM; Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Hasswa MK; Chest Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Sobhy D; Chest Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Ragheb CS; Resident of Internal Medicine. Master's Degree of Internal Medicine, Egypt.; Morad MA; Clinical Haematology Unit. Internal Medicine Department Kasr Alainy, Faculty of Medicine, Cairo University, Cairo, Egypt. |
| Source: | Respiratory medicine case reports [Respir Med Case Rep] 2021 Aug 21; Vol. 34, pp. 101495. Date of Electronic Publication: 2021 Aug 21 (Print Publication: 2021). |
| Publication Type: | Case Reports; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101604463 Publication Model: eCollection Cited Medium: Print ISSN: 2213-0071 (Print) Linking ISSN: 22130071 NLM ISO Abbreviation: Respir Med Case Rep Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Oxford] : Elsevier Ltd., c2012- |
| Abstract: | Unusual presentations of sarcoidosis pose a diagnostic challenge and warrant attention. Hematologic associations: Case 1 (37-years-old male): Pancytopenia: myelofibrosis (leading to sepsis and mortality) following a two-year quiescent course of biopsy-proven-sarcoidosis. Case 2 : (38-years-old male): Presentation with thrombocytopenia (5 × 103/cmm): immune thrombocytopenic purpura (histologically associated with megakaryocytic emperipolesis). Biopsied enlarged lymph nodes demonstrated sarcoidosis. Hematologic sarcoid involvement is usually due to granulomatous bone marrow (3.9%) or splenic infiltration (6-30%); however, the presented manifestations are scarcely reported with a potential significance that is yet to be elucidated. Case 3: Neurologic presentation: 48-years-old female: presentation with bilateral sensorineural hearing loss and facial palsy. Brain magnetic resonance imaging showed leptomeningeal thickening. Biopsied enlarged lymph nodes showed sarcoidosis. Case 4: Neurologic and renal manifestations: 13-years-old male (family history of sarcoidosis): Presenting with acute headache, investigations showed elevated serum creatinine (2.1 mg/dL) and angiotensin converting enzyme, and computed tomography chest and abdominal findings characteristic of sarcoidosis. Associated benign increased intracranial and acute tubulointerstitial nephritis (with eosinophils) were diagnosed upon concordant workup. Of sarcoidosis neurologic affection (5-10%), cranial nerve(s) involvement is among the most common (25-50% of neurosarcoid affection), particularly that of the facial nerve (Case 3). Leptomeningeal enhancement is among the most common neurosarcoid radiologic findings (30-40%). Whereas benign increased intracranial tension (Case 4) is much less reported. Among sarcoidosis renal involvement (35-50%), interstitial nephritis usually presents with granulomatous renal lesions, yet its sole association with sarcoidosis is unusual (Case 4). The portrayed atypical hematologic, neurologic, and renal manifestations further emphasize the masquerading nature of sarcoidosis.; (© 2021 The Authors.) |
| Competing Interests: | None. |
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| Contributed Indexing: | Keywords: Emperipolesis; Juvenile; Myelofibrosis; Neurosarcoidosis; Renal involvement; Sarcoidosis |
| Entry Date(s): | Date Created: 20210902 Latest Revision: 20210903 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC8390548 |
| DOI: | 10.1016/j.rmcr.2021.101495 |
| PMID: | 34471595 |
| Database: | MEDLINE |
Case Reports; Journal Article