Paraneoplastic Sarcoid-Like Reactions and the Eye

Purpose The advances in medicine have led to an increased number of people living with some form of immunodeficiency. Most ocular infections in immunocompromised patients may lead to irreversible blindness. We identify the causes of uveitis in immunocompetent and immunocompromised patients. Methods A retrospective cohort study of 1354 consecutive patients. All patients underwent a standard work‐up for uveitis. Results An immunocompromised state was identified in 171/1354 patients (13%), of whom 40 had Human immunodeficiency virus (HIV) infection, 52 received immunosuppressive medications, 28 had concurrent malignant disorder and 20 had other causes for their immunosuppression. In addition, 93/1354 patients (7%) had diabetes mellitus (DM). The prevalence of intraocular infections was much higher in immunocompromised patients than in immunocompetent patients and DM (p < 0.001). Causes of uveitis differed between the diverse immunocompromised groups. The non‐HIV immunocompromised patients showed primarily intraocular herpes simplex and varicella zoster virus infections, whilst HIV‐positive patients exhibited frequently cytomegalovirus (CMV) retinitis and syphilis. Patients with generalized malignancies were characterized by a lower prevalence of infections and higher prevalence of sarcoidosis. Patients with DM typically showed sarcoidosis and bacterial intraocular infections. The percentage of undetermined uveitis diagnoses was markedly lower in immunosuppressed patients (p < 0.001). Conclusion In immunocompromised patients with uveitis, infections were diagnosed in 46% of cases in contrast to 12% in the immunocompetent patients. The causes of uveitis differed among the various types of immunosuppression. Immunocompromised patients with uveitis require a rapid assessment for the most expected infections.

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“…Our study also demonstrates that sarcoid‐reactions in malignancies might include uveitis (Balasubramaniam et al. ).…”

Section: Discussionsupporting

confidence: 74%

Uveitis causes according to immune status of patients

Rothová

Hajjaj

Hoog

et al. 2018

Acta Ophthalmologica

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“…They showed that a SRSF2 P95 hotspot mutation, which usually occurs in 40–50% of CMML cases, was detected in skin and bone marrow biopsies in all of their cases . In our patient, the episcleritis and epithelioid cell‐like granuloma of the cervical lymph node resembled a sarcoid‐like reaction pattern, a process that resembles sarcoidosis but is secondary to an underlying disease such as CMML or other malignancies, also explaining the laboratory abnormalities such as serum neopterin, soluble interleukin‐2 receptor, beta 2 microglobulin and free light chains . Screening for underlying disease is therefore crucial in patients with PNGD and should include antinuclear antibodies, antineutrophilic cytoplasmic antibodies, rheumatoid factor, cyclic citrullinated peptide, a complete blood count with differential and electrophoresis with exclusion of a paraproteinemia.…”

supporting

confidence: 55%

Palisaded neutrophilic and granulomatous dermatitis in a patient with chronic myelomonocytic leukaemia

Kohlmann

Schüürmann

Simon

et al. 2019

Acad Dermatol Venereol

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“…The triggering mechanisms that induce sarcoid-like reactions may be categorized as following: 1) local reaction to infectious agents (leprosy, atypical mycobacterial infections, deep fungal reactions, etc.) [ 8 ][ 9 ][ 10 ]; 2) noninfectious but immunogenic antigens (inorganic compounds) [ 11 ][ 12 ]; 3) tumors (paraneoplastic sarcoid type of reaction) [ 13 ][ 14 ]. Our concepts of sarcoid - type reaction are based on the assumption that it may be provoked, in predisposed patients, by cross-reaction to immunogens or tumour antigens, so its pathogenesis is closely related to the generation of cross - mediated immunity presenting as molecular (antigen) mimicry.…”

Section: Discussionmentioning

confidence: 99%

Sarcoidosis in A. C. Milan (1899)?

Tchernev¹,

Lotti²,

Wollina³

et al. 2018

Open Access Maced J Med Sci

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The pathogenesis, diagnosis and therapy of sarcoidosis as an autonomous disease are subjects of spirited discussions, which haven’t found definitive conclusion yet. Distinguishing between sarcoidosis and sarcoid-like reactions (sarcoid - type granulomas) is not currently a medical “gold standard” and is not implemented in clinical practice. This leads to 1) misinterpretation of numerous available data; 2) difficulty in the interpretation of other unverified data, which is often followed by 3) inappropriate or inadequate therapeutic approach. Similarly to many other diseases, in sarcoidosis and sarcoid - types of reactions the concept of personalised approach and therapy should also be introduced. This methodology of clinical guidance is difficult, complex and not always achievable in the current medical status and relations (doctor-patient relationship; financial factor; time factor). It is appropriate to note that in some cases the guidelines or the so-called standards are neglected or not possible to put into practice with the aim of better therapeutic practices and strategies, as well as the achievement of optimal final clinical results (especially in patients with sarcoid granulomas). The sarcoid granuloma, even when it is sterile, should not be considered as the equivalent of sarcoidosis, i.e., sarcoidosis as an autonomous disease. Sure enough, exactly because of this fact, the personalised approach should not be an exception, but it has to gradually become a rule in medical practice. When clinical decisions are conformed to some of the latest modern concepts, officialised in the international databases, often the achieved results can be much better.We present a patient with a tattoo of AC Milan (1899) on his right arm, who subsequently developed localised sterile sarcoid granulomas in the area of the tattoo. Later the process became generalised on his whole body’s skin, lungs and lymph nodes. It is unclear for the moment whether this condition should be interpreted as sarcoidosis as an autonomous disease or, instead, as a sarcoidal type of reaction with subsequent generalisation due to cross-reactivity against antigens present in other tissues with similarities to the exogenous pigments. Following the modern concepts regarding the pathogenesis of these two conditions, we introduced, in this case, an innovative, non-standard approach: 1) systemic and local immunosuppressive therapy, combined with 2) recommеndation for immediate surgical excision of the tattoo to remove the possible trigger of molecular and antigen mimicry.

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Paraneoplastic Sarcoid-Like Reactions and the Eye

Abstract: Sarcoid-like reactions can occur in the eye, and ocular malignancies may incite sarcoid-like reaction. Ocular sarcoid-like reactions have paraneoplastic features in that they can occur at a site distant from malignancy and may precede, occur simultaneously with, or follow malignancy.

Cited by 14 publications

References 53 publications

Uveitis causes according to immune status of patients

Uveitis causes according to immune status of patients

Palisaded neutrophilic and granulomatous dermatitis in a patient with chronic myelomonocytic leukaemia

Sarcoidosis in A. C. Milan (1899)?

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