Manifestations ophtalmologiques de la sarcoïdose : que doit savoir l’interniste ?

Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which the internists face. This review reports the state of knowledge for these two ocular involvements and proposes an assessment-algorithm for sarcoidosis in patients with suspected sarcoid uveitis. Two groups of patients with sarcoid uveitis can be distinguished: one young and multiethnic group in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it could be a serious condition involving functional prognosis, an early recognition in addition to a growing therapeutic arsenal including intravitreal implant seems to have improved visual prognosis of the disease in the last years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema and occlusive vasculitis. In up to 25% of cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, including methotrexate, azathioprine, and mycophenolate mofetil. Regarding systemic sarcoidosis, infliximab and adalimumab have been successfully used for the treatment of refractory or sight-threatening disease. Optic neuropathy often affects women of African and Caribbean origin. Some authors recommend that patients be treated with high-dose corticosteroids and concurrent immunosuppression from the onset for this manifestation, which may be associated with a poorer outcome.     

Unusual eye manifestations in systemic lupus erythematosus patients

Summary One hundred and twelve records of patients with systemic lupus erythematosus were reviewed and four cases with unusual ocular manifestations are described. We found that anterior uveitis is not an uncommon manifestation of systemic lupus erythematosus and physicians must be aware of it during the patient's evaluation, since it can be treated without serious visual loss. Optic neuritis is uncommon in systemic lupus erythematosus and visual loss may be permanent despite therapy.     

Sarcoidosis presenting with tachy- and brady-arrhythmias.

We describe a case report of a 49-year-old man admitted to a cardiology unit with a series of arrhythmias with no initially obvious aetiology. Further assessment and the use of cardiac magnetic resonance imaging and histology allowed a diagnosis of cardiac sarcoidosis to be made. Cardiac sarcoidosis is a major cause of death in patients with systemic sarcoidosis. Cardiac magnetic resonance imaging is an additional diagnostic tool for this condition without ionizing radiation exposure.     

Coexistence of Sarcoidosis and Gouty Arthritis

Sarcoidosis is an inflammatory disease with unknown cause characterized by non-caseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, the involvement of eye and symptoms on the locomotor system. Gouty arthritis is an autoinflammatory disease characterized by hyperuricemia, recurrent arthritis attacks and the deposition of monosodium urate crystals in the joints and the surrounding tissues. We reported the coexistence of sarcoidosis and gouty arthritis in this paper.     

2型糖尿病性干眼患者眼表改变的研究进展

现今,伴随着2型糖尿病患病率日益增高的同时,以糖尿病性干眼为代表的眼表并发症亦引起了社会各界的重视。糖尿病性干眼因其病情容易反复发作,而不易根治,故而可对患者的身体健康和生活质量造成各种不利影响。因此,积极展开关于糖尿病性干眼方面的研究,具有重大意义。该文从近10年来,关于2型糖尿病性干眼的眼表结构及功能改变的研究现状,进行部分归纳与探讨,旨在日后更好的服务于临床。     

The Clinical and Radiologic Features of Nodular Pulmonary Sarcoidosis

STUDY OBJECTIVES: Nodular sarcoidosis is an uncommon presentation of sarcoidosis. Our objective was to describe the clinical characteristics of a large cohort of patients with nodular sarcoidosis. METHODS: We performed a retrospective study of patients with nodular sarcoidosis diagnosed at an urban teaching hospital over a 10-year period. RESULTS: Thirty-three patients with nodular sarcoidosis were identified. All patients were African-American. The mean age was 35 and the female-to-male ratio was 5:1. Twenty-six patients were current or former smokers. All patients had chest CT scan and/or chest radiograph evidence of pulmonary masses. Twenty-seven patients had multiple pulmonary masses/nodules and six had solitary pulmonary nodules/masses. The upper lobes were involved in 27 patients. Mediastinal lymphadenopathy and pleural-based masses were present in 30 and 20 patients, respectively. Extrapulmonary manifestations were present in 14 patients. All patients had tissue diagnosis of noncaseating granulomas with negative culture. Twenty-two patients underwent bronchoscopy with transbronchial biopsies, which were diagnostic in 19. Follow-up data were available on 27 patients: complete or nearly complete resolution of the pulmonary masses--either spontaneously or with systemic treatment--was documented for 19 patients, no change in the radiologic findings for 7 patients, and progression to pulmonary fibrosis for 1 patient. CONCLUSIONS: Nodular sarcoidosis is a rare presentation of pulmonary sarcoidosis. It usually presents with multiple pulmonary masses that tend to be peripheral and are associated with mediastinal lymphadenopathy. Bronchoscopy with transbronchial biopsies has high diagnostic yield. Despite its ominous presentation, nodular sarcoidosis has favorable prognosis.     

Uvéites sarcoïdosiques : regards croisés de l’ophtalmologiste et de l’interniste

Sarcoidosis is one of the leading causes of inflammatory eye disease. All ocular structures can be affected, but uveitis is the main manifestation responsible for vision loss in ocular sarcoidosis. Typical sarcoid anterior uveitis presents with mutton-fat keratic precipitates, iris nodules, and posterior synechiae. Posterior involvement includes vitritis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence of sarcoid uveitis. Patients with clinically isolated uveitis at diagnosis rarely develop other organ involvement. Even though, ocular sarcoidosis can have a severe impact on visual prognosis, early diagnosis and a wider range of available therapies (including intravitreal implants) have lessened the functional impact of the disease, particularly in the last decade. Corticosteroids are the cornerstone of treatment for sarcoidosis, but up to 30% of patients achieve remission with requiring high-dose systemic steroids. In these cases, the use of steroid-sparing immunosuppressive therapy (such as methotrexate) is unavoidable. Among these immunosuppressive treatments, anti TNF-α drugs have been a revolution in the management of non-infectious uveitis.     

Sarcoidosis Presenting as Colonic Polyposis: Report of a Case

A 47-year-old, West Indian male was referred for investigation of mild iron-deficiency anemia. He was asymptomatic. Two years earlier, he had an episode of transient facial weakness and a separate episode of diplopia. Gastroscopy and duodenal biopsies were normal. Barium enema demonstrated multiple small polyps throughout the colon. At colonoscopy, these polyps had the appearance of adenomatous polyps. Histology revealed noncaseous epithelioid granulomas. There were no acid-fast bacilli, no intervening colitis, and no features of Crohns disease on small-bowel radiology. Chest x-ray demonstrated bilateral hilar lymphadenopathy. A diagnosis of sarcoidosis with colonic involvement has been made. Sarcoid has been described at various sites in the gastrointestinal tract, presenting with stricturing or ulceration. There have been no previous reports of sarcoidosis presenting as discreet colonic polyps.