Pulmonary sarcoidosis: diagnostic and treatment update

Fahim, Ahmed; Mann, J

doi:10.1586/17476348.2014.919225

Cited by 6 publications

(5 citation statements)

References 43 publications

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“…Transbronchial biopsies help to obtain the histological diagnosis in support of clinical-radiological diagnosis especially when the superficial mucosal or cutaneous lesions are not amenable for sampling [13,14]. The diagnostic sensitivity of TBB in the diagnosis of a broad spectrum of interstitial lung diseases (ILDs) ranges from 29 to 79% [15][16][17][18][19].…”

Section: Bronchoalveolar Lavage (Bal) and Transbronchial Biopsy (Tbb)mentioning

confidence: 99%

Current Diagnostic Techniques in Sarcoidosis

Anandavelu¹,

Fahim²

2020

Sarcoidosis and Granulomatosis - Diagnosis and Management

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Sarcoidosis is an enigmatic disorder with a propensity for lung involvement in the majority of cases (~90%) and is characterized by noncaseating granulomatous inflammation on histological analysis. The techniques to establish the diagnosis have evolved over time, and a clear diagnostic algorithm for the clinicians dealing with this disease is desirable. Thoracic computed tomography is the imaging modality of choice in pulmonary sarcoidosis and provides accurate assessment of staging, parenchymal involvement, and response to immunomodulatory therapies. The advent of EBUS-TBNA has been a step forward with an excellent diagnostic yield in the presence of mediastinal/hilar lymphadenopathy and has replaced the traditional approach of obtaining biopsy samples via transbronchial and endobronchial routes. The preferred initial investigation for the confirmation of diagnosis is dependent on the organ involvement and the expertise available. A core biopsy of cervical lymph nodes is a less invasive and economical alternative in selected cases of suspected pulmonary sarcoidosis and warrants further evaluation in prospective manner to establish if it can be considered as a first-line investigation in all new cases suspected to have pulmonary sarcoidosis. A multidisciplinary approach is crucial for the diagnosis and management, and a simplified algorithm is proposed to help guide clinicians dealing with this disease of myriad clinical and radiological manifestations.

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Section: Bronchoalveolar Lavage (Bal) and Transbronchial Biopsy (Tbb)mentioning

confidence: 99%

Current Diagnostic Techniques in Sarcoidosis

Anandavelu¹,

Fahim²

2020

Sarcoidosis and Granulomatosis - Diagnosis and Management

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“…20 Moreover, HRCT findings may correlate much better with functional respiratory impairment. 21 There are several findings typical of sarcoidosis on HRCT including mediastinal lymphadenopathy, bilateral perihilar opacities, micro and macronodules, perilymphatic distribution, fibrotic changes, with a propensity for upper- and mid-lung predominance for parenchymal abnormalities. 20 In fact, in the appropriate clinical setting, a combination of micronodules with a perilymphatic and upper lobe distribution, together with subcarinal and symmetrical hilar lymph node enlargement is practically diagnostic of sarcoidosis and lung biopsy may not be required 14 (Table 1).…”

Section: Imagingmentioning

confidence: 99%

“…Although not as well studied as MTX, it seems to have a cure rate similar to MTX based on two retrospective cohort studies. 21 The typical initial dose is 10 mg daily, which can be increased in a few weeks to 20 mg daily if well tolerated.…”

Section: Other Antimetabolitesmentioning

confidence: 99%

Contemporary optimized practice in the management of pulmonary sarcoidosis

Aryal

2019

Ther Adv Respir Dis

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Pulmonary sarcoidosis is the most common form of sarcoidosis, accounting for the initial presentation in over 70% patients and with eventual presence in 90% of patients with sarcoidosis. However, the course of the disease is often unpredictable; its manifestations can be highly variable and its treatment may not be effective in all patients. As such, the optimized treatment of pulmonary sarcoidosis often requires a thoughtful personalized approach with the need to get the patient involved in decisions of management. In many patients with pulmonary sarcoidosis, the disease is self-limited and nonprogressive, thus treatment is not necessary. In other patients, the presence of significant symptoms or functional limitation often associated with worsening radiological changes and pulmonary function tests warrants treatment. Corticosteroids are the first-line treatment for pulmonary sarcoidosis; antimetabolites are second-line agents, with methotrexate being most commonly employed. Antitumor necrosis alpha antibodies, especially infliximab, are emerging as potential third-line agents. A high index of suspicion should be held for pulmonary hypertension and other comorbidities that may complicate the course of patients with advanced sarcoidosis. Lung transplantation may be the only option for patients who have refractory disease despite maximal medical therapy.

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“…NEUROSARCOIDOSIS.-Sarcoidosis is an inflammatory disorder involving multiple organ systems characterized by non-necrotizing granulomas; the majority of cases have pulmonary involvement. 124 Clinical manifestations typically occur in middle age, although neurologic involvement can occur at any stage of the disease and may present years after initial systemic symptoms. Neurologic complications occur in up to 10% of patients and may be the presenting symptom in a significant number of patients.…”

Section: Autoimmune Inflammatory and Vasculitic Etiologiesmentioning

confidence: 99%

Chronic Meningitis

Thakur¹,

Wilson²

2018

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: This article describes the clinical presentation, diagnostic approach (including the use of novel diagnostic platforms), and treatment of select infectious and noninfectious etiologies of chronic meningitis. RECENT FINDINGS: Identification of the etiology of chronic meningitis remains challenging, with no cause identified in at least one-third of cases. Often, several serologic, CSF, and neuroimaging studies are indicated, although novel diagnostic platforms including metagenomic deep sequencing may hold promise for identifying organisms. Infectious etiologies are more common in those at risk for disseminated disease, specifically those who are immunocompromised because of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), transplantation, or immunosuppressant medications. An important step in identifying the etiology of chronic meningitis is assembling a multidisciplinary team of individuals, including those with specialized expertise in ophthalmology, dermatology, rheumatology, and infectious diseases, to provide guidance regarding diagnostic procedures. SUMMARY: Chronic meningitis is defined as inflammation involving the meninges that lasts at least 4 weeks and is associated with a CSF pleocytosis. Chronic meningitis has numerous possible infectious and noninfectious etiologies, making it challenging to definitively diagnose patients. Therefore, a multifaceted approach that combines history, physical examination, neuroimaging, and laboratory analysis, including novel diagnostic platforms, is needed. This article focuses on key aspects of the evaluation of and approach to patients with chronic meningitis. Specific infectious etiologies and differential diagnoses of subacute and chronic meningitis, including noninfectious etiologies, are addressed.

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Pulmonary sarcoidosis: diagnostic and treatment update

Cited by 6 publications

References 43 publications

Current Diagnostic Techniques in Sarcoidosis

Current Diagnostic Techniques in Sarcoidosis

Contemporary optimized practice in the management of pulmonary sarcoidosis

Chronic Meningitis

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