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Bone marrow sarcoidosis

John Gubatan, Xiaohui Wang, Abner Louissaint, Anuj Mahindra, John Vanderpool
BACKGROUND: Bone marrow sarcoidosis is extremely rare. The association between sarcoidosis and lymphoproliferative disorders has been previously speculated, although the diagnosis of sarcoidosis often precedes any hematological derangements. CASE PRESENTATION: Here, we report for the first time, a case of a 57-year-old Caucasian woman with a previous diagnosis of monoclonal gammopathy of undetermined significance (MGUS) developing hypercalcemia and renal failure with workup notable for isolated bone marrow sarcoidosis and not multiple myeloma as expected...
2016: Biomarker Research
J Freyschmidt, P Freyschmidt
OBJECTIVE: Presentation of the etiology, pathology, clinical course, radiology and differential diagnostics of skeletal sarcoidosis. PATHOANATOMICAL PRINCIPLES: Noncaseating epithelioid cell granulomas can trigger solitary, multiple or disseminated osteolysis, reactive osteosclerosis and/or granulomatous synovitis. INCIDENCE: The incidence of sarcoidosis is 10-12 per 100,000 inhabitants per year. Skeletal involvement is approximately 14 %...
October 2016: Der Radiologe
Ashley Sweeney, Richard Hammer, Andrea Evenski, Julia Crim
We report a case of fulminant sarcoidosis in a 28-year-old man presenting with skin nodules, multifocal small and large joint arthralgias, and blurred vision. Characteristic bone, soft tissue, articular, and CNS findings were evident on multimodality imaging. Bony abnormalities included near-complete destruction of a distal phalanx, "lace-like" lucent lesions, erosive arthritis, lytic lesions with and without sclerotic margins, and bone marrow replacement visible only on MRI. The extent of bony disease at time of presentation was unusual...
November 2016: Skeletal Radiology
Ankur Jain, Pankaj Malhotra, Gaurav Prakash, Subhash Varma, Narender Kumar, Asim Das
Clinicians in hematology practice commonly encounter anemia, hypercalcemia and renal failure, which when present in combination evoke a diagnostic workup for multiple myeloma. We report a 71-years old lady who presented to our hematology clinic with fever and easy fatiguability of 3 months duration and on investigations was found to have anemia and hypercalcemia. Direct Coomb's test characterized the anemia as complement mediated (anti-C3d) hemolysis. Biochemical investigations revealed normal 25(OH) Vitamin D3 and suppressed Parathormone levels and a negative workup for plasma cell dyscrasias, sarcoidosis and autoimmune disorders...
June 2016: Indian Journal of Hematology & Blood Transfusion
Anjali Shetty, John D Carter
Sarcoidosis is an inflammatory, systemic disease characterized by noncaseating granulomas. We describe a case of a 52-year-old female who presented with fevers, chills, night sweats, and weight loss of four months' duration. Lymphoma was suspected, and results of advanced imaging procedures were also consistent with lymphoma. However, mediastinal lymph-node biopsy, bone-marrow aspiration, and biopsy revealed noncaseating granulomas. She was diagnosed with sarcoidosis and had a positive therapeutic response to drug therapy...
2011: Radiology case reports
Isidora Grozdic Milojevic, Dragana Sobic-Saranovic, Jelica Videnovic-Ivanov, Djordjije Saranovic, Strahinja Odalovic, Vera Artiko
BACKGROUND: Bone sarcoidosis is rare manifestation of disease usually accompanied with pulmonary involvement. Until today, exact prevalence of bone sarcoidosis is not known, since reported prevalence varies widely depending on the studied population and the used diagnostic techniques. OBJECTIVE: To determine the prevalence of bone involvement and distribution pattern in active chronic sarcoidosis by using FDG PET/CT. METHODS: Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination...
2016: Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG
P Thermann, M M Dollinger
Sarcoidosis is a rare systemic disease characterized by noncaseating granulomas in affected organs. With > 90 % of all cases lung involvement is the most frequent site of manifestation of sarcoidosis, nevertheless multiple other organs can be affected. Extrapulmonary manifestations are lymph nodes, skin, nervous system, heart, eyes, bone marrow, spleen or gastrointestinal tract including liver and pancreas. Involvement of the gastrointestinal tract is rare, it can affect the whole intestine and is most frequently found in the stomach...
March 2016: Zeitschrift Für Gastroenterologie
M Kinné, A Filleron, R Salet, L Saumet, S Baron Joly, T A Tran
Sarcoidosis is a systemic granulomatosis disease with a classic triad of presentation: typical clinical and radiological signs, presence of tuberculoid granuloma without caseum in histopathology, and exclusion of other causes of granulomatosis, especially tuberculosis. Sarcoidosis is rare in the general population, and even more so in children. In the literature, few cases of sarcoidosis associated with hypercalcemia have been reported in children. We report here the case of a 14-year-old boy with bone marrow and lymph node sarcoidosis suspected, based on poor general condition with hypercalcemia...
May 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Vidya Nair, Deepak Prajapat, Deepak Talwar
Literature on concurrent association of sarcoidosis with lymphoproliferative malignancies other than lymphoma e.g. multiple myeloma is meager. The rarity of the situation prompted us to report this patient who was a 51-year-old woman with a 2-years history of breathlessness, cough with expectoration, chest pain and backache. Initial evaluation revealed mild anemia, increased alkaline phosphatase with chest skiagram showing both lower zone non homogenous opacities with calcified hilar lymph nodes. CECT chest showed mediastinal with bilateral hilar lymphadenopathy, parenchymal fibrosis, traction bronchiectasis, ground glass opacities, septal and peribronchovascular thickening affecting mid and lower lung zones bilaterally...
January 2016: Lung India: Official Organ of Indian Chest Society
Arushi Khurana, Saira Cherian, Shounak Majumder, Radhika Nakrani, Gurukripa N Kowlgi, Constantin A Dasanu
Sarcoidosisis amultisystemic granulomatous disease, potentially affecting any organ system of the body. Calcium metabolism disturbances occur in up to 20% of patients, of which hypercalciuria and asymptomatic hypercalcemia are most common. Ocular sarcoid typically presents with anterior chamber manifestations such as uveitis, iritis, and iridocyclitis, but can involve posterior chamber as well. We describe herein a unique presentation of sarcoidosis with retinal detachment and symptomatic hypercalcemia as its first manifestation...
January 2016: Connecticut Medicine
Ralph Yachoui, Brian J Parker, Thanhcuong T Nguyen
Bone and bone marrow involvement in sarcoidosis have been infrequently reported. We aimed to describe the clinical features, radiological descriptions, pathological examinations, and outcomes of three patients with osseous sarcoidosis and one patient with bone marrow sarcoidosis seen at our institution. Our case series included fluorodeoxyglucose positron emission tomography descriptions in assessing the whole-body extent of sarcoidosis. In the era of advanced imaging, large bone and axial skeleton sarcoidosis lesions are more common than previously reported...
November 2015: Rheumatology International
Neeraj Sharma, Hassan Tariq, Kalpana Uday, Yevgeniy Skaradinskiy, Masooma Niazi, Sridhar Chilimuri
We discuss a case of a 61-year-old woman who presented with substernal chest pain. She was found to have elevated calcium levels, anemia, and acute kidney injury. The hypercalcemia persisted despite therapy with fluids and bisphosphonates. She was found to have nonparathyroid hormone (PTH) mediated hypercalcemia. The chest X-ray did not reveal any pathology. Our Initial impression was likely underlying hematologic malignancy such as lymphoma or multiple myeloma. A bone marrow biopsy was performed that revealed nonnecrotizing granulomatous inflammation...
2015: Case Reports in Medicine
Daniel H van Raalte, Susan M Goorden, Evelien A Kemper, Lodewijk A A Brosens, Reinier W ten Kate
Hypercalcaemia is frequently observed in patients with sarcoidosis. This is classically attributed to ectopic production of 1,25 dihydroxy vitamin D by sarcoid granulomas. We present a case of sarcoidosis-related hypercalcaemia with normal vitamin D levels. In this patient, production of parathyroid hormone-related peptide (PTHrp) was the cause for sarcoidosis-induced hypercalcaemia. As such, plasma PTHrp levels were increased and bone marrow granulomas stained positively for PTHrp expression. Medium-dose prednisolone treatment improved symptoms of sarcoidosis and normalised serum calcium, and PTHrp concentrations...
2015: BMJ Case Reports
Sophie Rolls, Catherine Hyams, Michael Sheaff, Terence C O'Shaughnessy
An Afro-Caribbean woman presented with worsening breathlessness, weight loss, lethargy and fevers, developing a bilateral florid erythematous rash on her legs. She was recently diagnosed with rheumatoid arthritis and bilateral hilar lymphadenopathy was found on thoracic CT imaging. She was tachycardic and investigations revealed pancytopenia, eosinophilia, raised serum ACE, acute kidney injury and deranged liver function tests. Biopsy of the lymphadenopathy revealed mixed lymphoid cells and liver biopsy revealed extramedullary haematopoiesis, with hypercellular marrow found on bone marrow biopsy...
2015: BMJ Case Reports
Giorgio Conte, Fabio Zugni, Marco Colleoni, Giuseppe Renne, Massimo Bellomi, Giuseppe Petralia
Bone involvement has been reported in 1-13% of patients with sarcoidosis. Both 18F-fluorodeoxyglucose ((18)F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) and conventional magnetic resonance imaging (MRI) are sensitive in detecting sarcoidosis bone lesions, but are not always reliable in differentiating sarcoidosis bone lesions from metastatic disease, thus often requiring bone biopsy. We describe the use of diffusion whole-body MRI for bone assessment in a patient with breast cancer and sarcoidosis, presenting with bone marrow lesions mimicking metastatic disease at (18)F-FDG PET/CT...
2015: Ecancermedicalscience
Sebastian Letterer, Ulrich Lindner, Heinz-Wolfram Bernd, Florian M Vogt, Udo Helmchen, Hendrik Lehnert, Christian S Haas
Sarcoidosis can affect all organs and may mimic a variety of other diseases. In the absence of typical pulmonary features, extrapulmonary manifestations may be difficult to diagnose. We describe here the very uncommon case of a patient with mild pulmonal involvement but distinct renal, bone marrow and lymph node sarcoidosis. Treatment with glucocorticoids significantly improved kidney function and normalized serum calcium levels as well as the blood count. This case underscores the importance of sarcoidosis to be considered as a differential diagnosis of renal failure associated with hypercalcaemia and nephrocalcinosis...
February 2011: NDT Plus
S Aptel, S Lecocq-Teixeira, P Olivier, D Regent, P Gondim Teixeira, A Blum
Whilst the detailed X-ray features of thoracic manifestations of sarcoidosis are now clearly defined and known by most radiologists, the same does not apply to osteoarticular and muscular features of the disease, which may however raise major diagnostic problems, either because they are the presenting features of the disease (7% of cases) or because they develop during its course. The bony lesions of sarcoid dactylitis (classical Perthes-Jüngling disease) are very characteristic and well known. Many other presentations of bone and bone marrow sarcoidosis may however raise major diagnostic difficulties, particularly uni- or multifocal osteolytic and sclerotic forms of the disease...
January 2016: Diagnostic and Interventional Imaging
Diego Luis Carrillo-Pérez, Elia Ixel Apodaca-Cháveza, Eduardo Carrillo-Maravilla, Mayra Mejía-Ávila, José Luis Hernández-Oropeza, Edgardo Reyes, Yemil Atisha-Fregoso, Gabriela Hernández-Molina
BACKGROUND: Clinical presentation of sarcoidosis varies according to race and geographical area. We describe the clinical spectrum and outcome of sarcoidosis in Mexican patients compared with other populations. METHODS: We reviewed the medical charts of 21 patients with sarcoidosis seen at a referral hospital in 1989-2012; organ involvement was assessed using the ACCESS instrument. We compared our results with the ACCESS and Latin American studies. We used descriptive statistics and reported odd ratios with 95% CI...
January 2015: Revista de Investigación Clínica; Organo del Hospital de Enfermedades de la Nutrición
Abraham Gedalia, Tahir A Khan, Avinash K Shetty, Victoria R Dimitriades, Luis R Espinoza
A retrospective chart review was conducted to detect patients with sarcoidosis seen by pediatric rheumatology service from the period of 1992 to 2013 at Children's hospital of New Orleans. Twenty-seven patients were identified. The average duration of symptoms before diagnosis was 5 (range 1-120) months. Five patients had onset before the age of 5 years and were diagnosed with early-onset sarcoidosis. The most common manifestations at presentation were constitutional symptoms (62 %) followed by ocular (38 %)...
July 2016: Clinical Rheumatology
Esmaeil Mortaz, Hoda Gudarzi, Payam Tabarsi, Ian M Adcock, Mohamad Reza Masjedi, Hamid Reza Jamaati, Johan Garssen, Ali Akbar Velayati, Frank A Redegeld
The use of flow cytometry in the clinical laboratory has grown substantially in the past decade. Flow cytometric analysis provides a rapid qualitative and quantitative description of multiple characteristics of individual cells. For example, it is possible to detect the cell size and granularity, aspects of DNA and RNA content and the presence of cell surface and nuclear markers which are used to characterize the phenotype of single cells. Flow cytometry has been used for the immunophenotyping of a variety of specimens including whole blood, bone marrow, serous cavity fluids, (cerebrospinal fluid) CSF, urine and all types of body fluids...
February 2015: Iranian Journal of Allergy, Asthma, and Immunology
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