Sarcoidosis and autoimmune disorders. A case report and review of the literature

Abstract

SummarySarcoidosis is a multisystem disease of unknown etiology characterized by clusters of non-necrotizing granulomas and distortion of surrounding tissue. Although some patients are asymptomatic, sarcoidosis can cause a wide range of signs and symptoms often mimicking autoimmune rheumatologic disorders. Combined sarcoidosis and autoimmune disorders is uncommon as a result of either an University Hospital database analysis and literature review. However, given the high prevalence of autoimmunity in the general population, clinicians should be alerted to correctly diagnose and manage patients suspected to have both sarcoidosis and autoimmune disorders. KEY WORDS: sarcoidosis, autoimmunity, connective tissue disease. IntroductionSarcoidosis is a systemic inflammatory disorder that involves multiple tissues and is characterized by a non-caseating granulomatous reaction (1). Despite the etiology is not well understood, there are cellular immune system activation and nonspecific inflammatory response similar to some rheumatologic disease which are considered to play an important role in the pathogenesis (2). Sarcoidosis has been reported in all races and ethnic groups with a marked variations. People from different ages can be affected, but it is particularly sighted among the young adults whose ages range from 20 to 40, with possibly a second peak © C I C E d i z i o n i I n t e r n a z i o n a l i both legs together with the appearance of multiple skin papules. A skin biopsy revealed noncaseating epithelioid genulomas, consistent with the diagnosis of sarcoid granulomatosis dermatitis. Then, the patient started a treatment with oral prednisolone tablets (initially 0.75mg/kg body weight then tapering) showing a complete recovery of both skin lesions and leg sign and symptoms. Recognition of cutaneous sarcoid lesions was important in our patient because they provided a visible clue to the contribution of sarcoidosis for patient symptoms. Nevertheless, the diagnosis of cutaneous lesions in a patient with RA and sarcoidosis may be misleading because lesions can exhibit many different morphologies common to both diseases. Literature reviewSarcoidosis is a T helper 1 (Th1) mediated granulomatous disease, with unknown etiology, involving more than one organ. Sarcoidosis may mimic a number of rheumatic diseases or may coexist side by side. It can commonly present with clinical findings that are indicative of vasculitis and spondyloarthritis or connective tissue diseases, including both primary Sjogren's Syndrome, Systemic Lupus Erythematosus, rheumatoid arthritis, and sarcoidosis (1). Some constellations of clinical signs or symptoms are almost pathognomonic for sarcoidosis, including bilateral hilar nodal enlargement as an isolated clinical finding, erythema nodosum with bilateral hilar adenopathy (Lofgren Syndrome), and uveitis combined with fever plus parotiditis (Heerfordt Syndrome). Excluding Lofgren's and Heerfordt's Syndromes, the diagnosis of sarcoidosis requires a tissue biopsy confirming granulomatous inflammat...