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The respiratory system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
A quarter of patients have a dry cough, dyspnoea, and exercise intolerance, and another quarter present with eye, skin, or nasal complaints. Bilateral hilar lymphadenopathy and/or lung involvement is common. A third have fever, fatigue, malaise, and weight loss. Only in 15% of patients is the disease progressive and 40% have few symptoms. Depending on the degree of lung damage, there may be loss of lung volume and decreased diffusion capacity due to interstitial fibrosis (see also Case History 4.1, Chapter 4).
Medicine
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 33-year-old lady was found to have bilateral hilar lymphadenopathy on a chest X-ray, which was part of a septic screen during a recent admission to hospital in which she was treated for pyelonephritis. Following a transbronchial biopsy, she is diagnosed with sarcoidosis and started on prednisolone. Give two other possible causes of bilateral hilar lymphadenopathy. (2)What is likely to have been seen on the biopsy? (1)Give four extrapulmonary manifestations of sarcoidosis. (2)Give two pieces of advice you would give her prior to starting long-term corticosteroids. (2)Give six side effects of long-term corticosteroids. (3)
Respiratory medicine
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
The most common causes of bilateral hilar lymphadenopathy are: sarcoidosistuberculosislymphomaother malignancypneumoconiosis, e.g. berylliosisfungi, e.g. histoplasmosis, coccidioidomycosis
Unilateral Retinal Arteritis and Macroaneurysm in Sarcoidosis
Published in Ocular Immunology and Inflammation, 2022
Raziyeh Mahmoudzadeh, Anand Gopal, Rebecca Soares, James P. Dunn
Given optic nerve involvement, the patient was referred to neuro-ophthalmology for evaluation; however, the patient was shortly thereafter hospitalized for chest pain and shortness of breath. Serologic investigations of the following were negative or non-reactive: rapid plasma reagin (RPR)/ fluorescent treponemal antibody absorption (FTA-ABS) testing and QuantiFERON-TB Gold. Serum angiotensin-converting enzyme (ACE) was normal 48 U/L (normal range 14–82 U/L). Chest radiography on admission demonstrated bilateral hilar lymphadenopathy. Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain and orbits revealed enhancement of both optic nerves and multiple regions involving the bony skull base and sinuses. Lumbar puncture showed normal cerebrospinal fluid (CSF) cell counts, protein, and glucose.
Intermediate Uveitis Associated with Tattooing of Eyebrows as a Manifestation of Systemic Sarcoidosis: Report of Two Cases
Published in Ocular Immunology and Inflammation, 2021
Nazanin Ebrahimiadib, Farid Adelpour, Mohammadreza Ghahari, Mohammad Mehrpour
A 49-year-old woman presented with 3 months history of pain, photophobia, and foreign body sensation in both eyes. She also complained of pain and swelling on her left eyebrow which received permanent make-up tattooing 6 months ago. In the clinical exam, she had best visual acuity of 9/10 in both the eyes. On her left eyebrow, she had red, scaling papule on the site of her tattooing (Figure 2a). Slit lamp examination revealed fine KPs on corneal endothelium, in addition to 1+ grade cell reaction in anterior chamber and vitreous bilaterally. Posterior segment fluorescein angiography demonstrated retinal vasculitis, optic disc and macular leakage in both the eyes (Figure 2b,c). Laboratory tests (ACE: 112 U/L, normal range: 8–65 U/L). PPD was negative. Chest X-ray and CT scan showed bilateral hilar lymphadenopathy (Figure 3a, b). There was a nodule in the scalp where she had no tattoo. Biopsy of this nodule revealed non-caseating granuloma consistent with diagnosis of systemic sarcoidosis (Figure 4). Her chief complaint was of keratoconjunctivitis sicca type and uveitis was an incidental finding. She responded well to local and systemic corticosteroids and methotrexate.
Development of Vitreoretinal Lymphoma in a Patient with Sarcoid Uveitis
Published in Ocular Immunology and Inflammation, 2020
Lucie Wartique, Yvan Jamilloux, Audrey De Parisot De Bernecourt, Laurent Kodjikian, Hervé Ghesquieres, Christophe Ide, Pascal Sève
Sarcoidosis is a chronic granulomatous disease of unknown etiology characterized by non-caseified granulomas in many different organs and systems.1 The disease most frequently manifests with bilateral hilar lymphadenopathy and infiltrations in the lungs and skin, as well as with eye lesions. It may mimic a number of systemic diseases and/or accompany them. The development of lymphoma in patients with sarcoidosis is well established and was named the sarcoidosis lymphoma by Brincker in 1986.2 Herein, we describe a female patient followed up with biopsy-proven sarcoid uveitis for 7 years who developed chronic bilateral intermediate uveitis and progressive worsening of unsteady gait. Magnetic resonance imaging (MRI) of the brain and cerebral spinal analysis were suggestive of neurosarcoidosis. As the patient did not respond to steroids, a vitrectomy and a cerebral stereotaxic biopsy were performed and revealed diffuse large B-cell lymphoma. The patient died despite the chemotherapy with an initial improvement of visual and neurological features.