Sarcoidosis

Cooper, Denrick; Suau, Salvador

doi:10.1016/j.emc.2021.08.012

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…These individuals should be referred to a subspecialist or subspecialty center for comprehensive management. 119 Indications for specialty referral include (1) diagnostic uncertainty, (2) the need for second- or third-line immunosuppression agents for refractory disease, and (3) severe cardiac manifestations such as recurrent VT or end-stage HF.…”

Section: Treatmentmentioning

confidence: 99%

“…The multidisciplinary team may comprise an advanced HF cardiologist, electrophysiologist, advanced cardiac imager, pulmonologist, rheumatologist, and other extracardiac organ–specific specialists such as a neurologist or ophthalmologist, as well as advanced practice professionals, including nurse practitioners, and pharmacists. 119,120 Pulmonologists are integral because lung involvement is observed in >90% of individuals with sarcoidosis. 121 Rheumatologists and other extrapulmonary organ–specific medical specialists provide expertise in diagnosis and therapies.…”

Section: Treatmentmentioning

confidence: 99%

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Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Cheng,

Kittleson,

Beavers

et al. 2024

Circulation

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Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Cheng,

Kittleson,

Beavers

et al. 2024

Circulation

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“…Noncaseating necrotizing granuloma is the histopathological key to sarcoidosis and is the most important diagnostic clue for correctly defining sarcoidosis. However, biopsy is invasive, and interventional access to the mediastinum introduces inherent risks (such as infection and bleeding) to patients, as well as sampling errors [ 11 ]. If certain imaging features are highly correlated with sarcoidosis, biopsy can be avoided in some cases.…”

Section: Diagnostic Value Of Imaging In Pulmonary Sarcoidosismentioning

confidence: 99%

Diagnostic Value of Imaging and Serological Biomarkers in Pulmonary Sarcoidosis

Li,

2024

ARM

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Sarcoidosis is a multisystem granulomatous disease of an unknown aetiology. It can exist in many organs. Pulmonary and intrathoracic lymph nodes are most commonly involved. Lung sarcoidosis is uncommon in Asia. However, due to the large population of our country and the development of bronchoscopy, percutaneous lung puncture, and other medical technologies, the number of pulmonary sarcoidosis patients is on the rise. Pulmonary sarcoidosis patients have no obvious symptoms in the early stage, and the clinical manifestations in the later stage may vary from person to person. Eventually, the disease progresses to life-threatening pulmonary fibrosis. Therefore, patients with pulmonary sarcoidosis should receive a timely diagnosis. In recent years, the imaging features and serologic biomarkers of pulmonary sarcoidosis have been continuously studied. The diagnostic value of imaging and serologic biomarkers for pulmonary sarcoidosis is summarized below.

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“…Certain microorganisms, such as Propionibacterium and Mycobacterium, have also been linked, but the connection is unclear. Vimentin, a structural protein, may also play a role [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Definitive diagnosis is through histopathologic confirmation after biopsy, which typically will be obtained from the most accessible organ involved, preferably lymph nodes or skin. Infiltration with non-caseating granulomas represents the hallmark of the disease and many times will lead to organ architecture distortion [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A Rare Presentation of Sarcoidosis in a Young Male With Acute Renal Failure: A Case Report and Literature Review

De la Hoz,

Osman,

Ryad

et al. 2023

Cureus

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Sarcoidosis presents in a variety of ways, but historically, renal involvement has been considered rare with an incidence of 0.7% and is seldom the presenting feature of the illness. Concomitant involvement of kidney and bone marrow is extremely rare. Atypical forms of presentation, such as in this case, may pose a true diagnostic challenge. A 20-year-old African-American male presented to the emergency department with vague symptoms including fatigue, malaise, anorexia, right-sided lower back pain, and nausea. Acute kidney injury was clearly evident, creatinine was 19.78 mg/dL (normal range 0.60-1.20 mg/dL), and BUN was 124.0 mg/dL (normal range 5.0-25.0 mg/dL). Laboratory results were also remarkable for leukopenia, microcytic anemia, hyperkalemia, anion gap metabolic acidosis, and non-PTH dependent hypercalcemia. Interestingly, urinalysis was equivocal and both chest x-ray (CXR) and abdominopelvic computed tomography (CT) scan were unrevealing. The patient was admitted to the hospital and required renal replacement therapy to stabilize his clinical condition while planning for a renal biopsy that was later performed. While awaiting pathological results, pancytopenia developed, and a bone marrow biopsy was then obtained. On further investigation, angiotensin-converting enzyme (ACE) turned out to be significantly elevated suggesting sarcoidosis. Renal biopsy showed moderate acute tubular injury, tubulitis, extensive interstitial edema, and infiltration by numerous non-caseating granulomas, which confirmed the diagnosis of sarcoidosis. Bone marrow histopathology revealed hypocellularity but no granulomatous infiltration. The patient remained largely asymptomatic throughout his hospital stay, with no signs or symptoms suggesting the involvement of other organs. High-dose corticosteroids were started and continued outpatient after discharge while still on hemodialysis. Pancytopenia resolved while on glucocorticoids and improvement in renal function was such that after roughly two months of steroids, renal replacement therapy was no longer necessary. Overall, kidney injury severe enough to require hemodialysis associated with pancytopenia in a previously healthy 20-year-old constitutes a rather rare sarcoidosis presentation. This highlights the importance of considering sarcoidosis as a possible cause of kidney and bone marrow dysfunction and emphasizes the need for timely biopsy to facilitate accurate diagnosis and early initiation of appropriate therapy to avoid delayed or inadequate care, especially considering that even severe damage is potentially reversible when identified early and treated promptly.

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Sarcoidosis

Cited by 7 publications

References 28 publications

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Diagnostic Value of Imaging and Serological Biomarkers in Pulmonary Sarcoidosis

A Rare Presentation of Sarcoidosis in a Young Male With Acute Renal Failure: A Case Report and Literature Review

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