The spectrum of opportunistic diseases complicating sarcoidosis

Jamilloux, Yvan; Valeyre, Dominique; Lortholary, Olivier; Bernard, C.; Kerever, Sébastien; Lelièvre, L; Néel, A.; Broussolle, C.; Sève, P.

doi:10.1016/j.autrev.2014.10.006

Cited by 45 publications

(47 citation statements)

References 134 publications

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“…In some patients, symptom improvement occurred with aldosterone blockade with spironolactone. Cryptococcal infections were reported in two cases (4%), and these infections have also been reported in other studies of sarcoidosis patients [25,26]. These opportunistic infections are more common in patients treated with glucocorticoids alone or with other immunosuppressants [26].…”

Section: Discussionsupporting

confidence: 68%

A retrospective pilot study examining the use of Acthar gel in sarcoidosis patients

Baughman

Barney

O'Hare

et al. 2016

Respiratory Medicine

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Section: Discussionsupporting

confidence: 68%

A retrospective pilot study examining the use of Acthar gel in sarcoidosis patients

Baughman

Barney

O'Hare

et al. 2016

Respiratory Medicine

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“…Guidelines for specific agents such as methotrexate and the anti-TNF agents have been developed [51,52,65]. Fortunately, most sarcoidosis patients do not acquire opportunistic infections despite prolonged immunosuppressive therapy [66,67]. One of the recommendations of the panel was the use of pneumocystis prophylaxis in patients on high-dose immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis

et al. 2020

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Pulmonary sarcoidosis presents substantial management challenges, with limited evidence on effective therapies and phenotypes. In the absence of definitive evidence, expert consensus can supply clinically useful guidance in medicine. An international panel of 26 experts participated in a Delphi process to identify consensus on pharmacological management in sarcoidosis with the development of preliminary recommendations.The modified Delphi process used three rounds. The first round focused on qualitative data collection with open-ended questions to ensure comprehensive inclusion of expert concepts. Rounds 2 and 3 applied quantitative assessments using an 11-point Likert scale to identify consensus.Key consensus points included glucocorticoids as initial therapy for most patients, with non-biologics (immunomodulators), usually methotrexate, considered in severe or extrapulmonary disease requiring prolonged treatment, or as a steroid-sparing intervention in cases with high risk of steroid toxicity. Biologic therapies might be considered as additive therapy if non-biologics are insufficiently effective or are not tolerated with initial biologic therapy, usually with a tumour necrosis factor-α inhibitor, typically infliximab.The Delphi methodology provided a platform to gain potentially valuable insight and interim guidance while awaiting evidenced-based contributions.

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“…Since the causes of initial liver disease were very heterogeneous (cryptogenic cirrhosis, secondary biliary cirrhosis, hepatitis C virus‐ and hepatitis B virus‐related cirrhosis, alcoholic cirrhosis), it cannot be suspected that there is a direct relation between the initial cause of liver failure and PML. Interestingly, one of our patients suffered from sarcoidosis, and PML is one of the opportunistic infections that can occur in a setting of sarcoidosis, including also mycobacterial infection, cryptococcosis, and aspergillosis . Unlike peripheral lymphocytopenia, steroids are a major risk factor for such opportunistic infections, but the occurrence of opportunistic infections in untreated patients suggests more complex predisposing mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Progressive multifocal leukoencephalopathy after liver transplantation can have favorable or unfavorable outcome

Dumortier

Guillaud

Bosch

et al. 2016

Transplant Infectious Dis

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Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the JC polyomavirus (JCPyV) in immunocompromised patients, including solid organ transplant recipients. We report 2 cases of PML late after liver transplantation (144 and 204 months) and review the few other published cases. The clinical course of PML is characterized by a rapid progressive neurological decline coinciding with the presence of white matter lesions on magnetic resonance images. No direct antiviral therapy is available against the JCPyV. The prognosis is therefore extremely poor. Restoration of the immune response achieved by tapering or ending the immunosuppressive therapy is the basis of treatment in transplanted patients. One of our patients is alive 3 years after diagnosis after total withdrawal of immunosuppressive therapy. The other presented severe rejection when tapering immunosuppression and died 26 months after diagnosis.

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The spectrum of opportunistic diseases complicating sarcoidosis

Cited by 45 publications

References 134 publications

A retrospective pilot study examining the use of Acthar gel in sarcoidosis patients

A retrospective pilot study examining the use of Acthar gel in sarcoidosis patients

Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis

Progressive multifocal leukoencephalopathy after liver transplantation can have favorable or unfavorable outcome

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