Joint manifestations in sarcoidosis

The commonest type of joint involvement in sarcoidosis is the acute arthritis of the L ofgren syndrome. This usually precedes the erythema nodosum and regresses in a few weeks. Arthritis without erythema nodosum is less common and has a much more variable presentation. Chronic sarcoid polyarthritis is very rare and does not usually cause bone erosion or deformation. It is usually associated with involvement of other organs. In children, sarcoid polyarthritis may resemble Still's disease. The entity of sarcoid sacro iliitis is discussed. Rare cases of sarcoid spondylodiscitis simulating bacterial spondylodiscitis have been described.     

Ocular manifestations in sarcoidosis

Ocular complications of sarcoidosis are encountered in about a third of cases. They are subacute or chronic conditions, the commonest being anterior, middle and posterior uveitis, and involvement of lacrimal apparatus. The measurement of the angiotensin converting enzyme has thrown new light on these troublesome problems.     

Biological manifestations of sarcoidosis

Sarcoidosis is a multisystem granulomatous disease of unknown origin. No single biological marker allows definitive diagnosis of sarcoidosis or may accurately predict the disease prognosis. However, some biological markers are helpful tools as diagnostic aids and disease activity markers. At the blood level, lymphopenia with CD4 depletion, elevated levels of serum-angiotensin converting enzyme, lyzozyme, beta 2 microglobulin and disturbed calcium metabolism resulting in hypercalcemia and hypercalciuria can help guide diagnosis. Lymphocytic alveolitis with a high CD4/CD8 ratio in bronchoalveolar lavage fluid is highly suggestive of the disease. A wide range of new biological markers are proposed but their pronostic significance is still controversial. In clinical practice, biological markers may help in monitoring treated patients with sarcoidisis.     

Ophthalmologic manifestations of sarcoidosis

Ophthalmologic manifestations of sarcoidosis are polymorphous and can involve all the ocular structures. Benign conjunctive and lacrimal gland involvement predominates. Uveitis is found in 20% of the patients and is often torpid, becoming chronic. Systematic screening for uveitis is warranted in sarcoidosis patients. neuro-ophthalmologic involvement is exceptional and severe, raising major diagnostic difficulties when isolated.     

结节病的关节表现

目的：分析结节病的临床表现特点，以提高对结节病关节表现的认识。方法：回顾性分析经病理证实的63例结节病患者临床资料。结果：13例出现关节表现（20．6％）。7例为关节炎，其中5例在病程中发生关节炎的关节数≤4个，以膝、踝、腕等大关节受累为主，．多呈非对称性；2例在病程中发生关节炎的关节数≥5个；6例为关节痛。结论：结节病的关节表现分为少关节炎、多关节炎和关节痛3种类型。其关节表现有一定的特点，但无特异性。对出现关节损害者，需考虑到结节病的可能。     

Nonpulmonary manifestations of sarcoidosis

Sarcoidosis is one in a heterogeneous family of granulomatous disorders. The clinical manifestations of sarcoidosis can vary widely, depending on the patient and the tissues involved. Recent advances in our understanding of the immunologic steps leading to granuloma formation and persistence have yet to translate into more effective care for patients with this disease. This review discusses the immunology of granuloma formation and systemic disease, the various nonpulmonary expressions of the clinical disease, and the treatment options available to the practicing physician.     

Ocular manifestations of sarcoidosis

Ophthalmic involvement in sarcoidosis may cause significant sight-threatening illness for patients. Studies of patients with histologically proven sarcoidosis have found 25 to 50% of patients to have ocular manifestations. The frequency in which eye disease is seen and the course that it takes vary with age, race, and geography. This article discusses relevant aspects of the ocular manifestations of sarcoidosis for the internist and pulmonologist. Overall disease presentation, specific types of ocular involvement, evaluation strategies, and treatment considerations are discussed.     

Rheumatologic manifestations of sarcoidosis

PURPOSE OF REVIEW: This review emphasizes the importance of the rheumatological signs and symptoms in the presentation of sarcoidosis. Often the presence of musculoskeletal findings may lead to the diagnosis of the disease and the institution of the appropriate treatment. RECENT FINDINGS: There have been significant advances in the treatment of sarcoidosis with the use of biologic agents for recalcitrant and severe manifestations of the disease as well as some new data regarding pathogenetics and new applications of diagnostic imaging studies such as positron emission tomography scanning. SUMMARY: Although pulmonary disease is the most frequent manifestation of sarcoidosis, musculoskeletal symptoms are not only common, but may be the initial presentation of this systemic inflammatory process and could mimic other arthritic and autoimmune disorders. This article focuses on the rheumatological aspects of sarcoidosis and includes a review of the most recent literature, which shows new data on the diagnosis, pathogenesis, and treatment of this condition.     

Airway manifestations of sarcoidosis in adolescents

Endobronchial sarcoid lesions have previously been described and visualized upon bronchoscopy in adult patients with pulmonary sarcoid involvement. Endobronchial ultrasound‐guided transbronchial fine‐needle aspiration (EBUS‐TBNA) has come into favor as the preferred method of diagnosis, but it remains a novel technique in pediatric pulmonology. We describe the first two known cases of visualized endobronchial sarcoid lesions in the pediatric population with pathological confirmation of sarcoidosis with endobronchial and EBUS‐TBNA biopsies.     

肺结节病46例病理及胸部CT特征

目的探讨肺结节病的病理和影像学特征，提高临床诊断水平。方法回顾性分析2000年1月至2005年8月在北京协和医院住院的46例肺结节病患者的病理和影像学资料。结果46例肺内结节病患者支气管肺泡灌洗液中淋巴细胞为0．47±0．18，CD4／CD8为6．63±4．51，血清血管紧张素转化酶（ACE）水平为（47±16）U／L。12例胸部CT表现为纵隔肺门淋巴结对称性肿大。16例表现为肺内结节影，沿支气管纹理分布或散在随机分布，呈粟粒状。多发斑片状（实变影）为13例。双肺磨玻璃样变为5例；13例经开胸、胸腔镜和纵隔镜取病理，33例行经皮肺活检、经支气管镜黏膜或肺活检。镜下可见病变内无干酪坏死上皮样结节。结节间可见无细胞成分的玻璃样变物质。结节围绕血管、淋巴管及支气管黏膜下分布，部分病例可见肉芽肿性血管炎。结论肺结节病胸部CT表现多样，确诊需要临床、支气管肺泡灌洗液检测结果和病理学表现并结合糖皮质激素疗效综合判断。     

The radiologic manifestations of Legionella pneumonia

A number of radiologic features on chest X-ray may aid in diagnosis and management of the patient with legionella infection. The infiltrates in legionnaires' disease frequently progress despite initiation of appropriate antibiotic therapy. Pleural effusion is common and occasionally seen even in the absence of lung field infiltrates. Pleural-based infiltrates associated with pleuritic pain may mimic pulmonary embolism. Circumscribed peripheral densities are commonly seen in immunosuppressed patients. Cavitation is also a prominent feature in this patient group and may develop during clinical improvement. Radiographic severity does not correlate with clinical outcome. Resolution of infiltrates may be slow, and the tendency for delayed clearing should be considered before initiating further invasive diagnostic investigation. Infections due to Tatlockia (Legionella) micdadei and Legionella bozemanii are more commonly reported in immunocompromised hosts; the radiographic manifestations are similar to those seen in Legionella pneumophila infection in the immunosuppressed.     

Unusual radiologic manifestations of the echinococcus infection in the thorax

Unusual location and presentation of hydatid cyst disease in the thorax requires careful consideration with respect to clinical approach and therapy. In this pictorial essay, we present imaging findings and describe treatment of thoracic hydatid cysts in patients with lung, mediastinal, chest wall, cardiac, endobronchial, pulmonary artery, and diaphragmatic involvement. A review of the literature is also included.     

Gastrointestinal and hepatic manifestations of sarcoidosis

Sarcoidosis is a multisystem disease characterized by noncaseating granulomas in the affected organs, including skin, heart, nervous system, and joints. Diagnosis of sarcoidosis is generally based upon a compatible history, demonstration of granulomas in at least two different organs, negative staining and culture for acid fast bacilli, absence of occupational or domestic exposure to toxins, and lack of drug-induced disease. Involvement of the hollow organs is rare. Rather than being due to sarcoidosis, some reported mucosal lesions may simply have incidental granulomas. Extrinsic compression from lymphadenopathy can occur throughout the gastrointestinal tract. The stomach, particularly the antrum, is the most common extrahepatic organ to be involved, while the small bowel is the least common. Liver involvement frequently occurs and ranges from asymptomatic incidental granulomas to portal hypertension from granulomas in the portal triad, usually with relatively preserved liver function. CT scans show hepatosplenomegaly and adenopathy, followed in frequency by focal low-attenuation lesions of the liver and spleen. Ascites is usually a transudate from right heart failure (because of pulmonary hypertension) or portal hypertension (because of biliary cirrhosis). Rarely, an exudative ascites may occur from studding of the peritoneum with nodules. Pancreatic involvement presents as a mass, usually in the head or a diffusely firm, nodular organ. Corticosteroids should be instituted when organ function is threatened, usually lungs, eyes, and central nervous system. Their role in the treatment of hepatic sarcoidosis is unclear. The overall prognosis is good although most patients will have some permanent organ impairment. Cardiac and pulmonary diseases are the main causes of death.     

Renal manifestations of sarcoidosis. A report of nine cases

PURPOSE: Clinical renal outbreaks occurring in the course of sarcoidosis are polymorphous. METHODS: Nine patients presenting with sarcoidosis were followed up for 18 years. RESULTS: Five patients presented with chronic interstitial nephritis. Renal failure accompanying granuloma was also present in three of them. Corticotherapy allowed rapid improvement in renal function in three patients. In two other cases, late treatment prevented recovery and led to end-stage renal failure in one case. In another case, persistent hypercalciuria was responsible for bilateral nephrolithiasis further treated via extracorporeal lithotrity. One case of mesangial glomerulonephritis and two morbid associations (retroperitoneal fibrosis and Henoch-Sch?nlein purpura) were observed. CONCLUSION: Interstitial nephritis is still a severe clinical renal outbreak. Corticotherapy must be prescribed early to avoid renal failure. Calcium metabolism disorders are frequent and often combined with interstitial nephritis. Hypercalcemia can often and rapidly be improved via corticotherapy, while monitoring of hypercalciuria proves to be more difficult. Membranous glomerulonephritis is still the most frequently reported glomerular lesion.     

Clinical and radiologic manifestations of hypersensitivity pneumonitis

Hypersensitivity pneumonitis (HP) is an inflammatory interstitial lung disease caused by recurring exposure to a variety of occupational and environmental antigens. It features widely variable clinical, radiologic, and histopathologic findings. Because the clinical findings of HP mimic multiple other diseases, a high degree of clinical suspicion and a thorough occupational and environmental history are essential for accurate diagnosis. There is no single pathognomonic feature for HP; rather, diagnosis relies on a constellation of clinical, radiologic, and pathologic findings. The radiologic manifestations, particularly the high-resolution computed tomography (HRCT) pattern, provide important clues and frequently point clinicians towards the correct diagnosis. The HRCT findings in HP may include ground-glass opacification, centrilobular nodules, air trapping (mosaic pattern), fibrosis, emphysema, or more frequently a combination of these. The combination of a mosaic pattern with ground-glass opacification and centrilobular nodules is particularly suggestive of the diagnosis. The best long-term prognosis is achieved with early diagnosis and removal from exposure.