The Sudden Development of Multi-Organ Lesions in a Patient With Pulmonary Sarcoidosis: A Case Report
Identifieur interne : 000318 ( Pmc/Checkpoint ); précédent : 000317; suivant : 000319The Sudden Development of Multi-Organ Lesions in a Patient With Pulmonary Sarcoidosis: A Case Report
Auteurs : Mohamed A. Abdallah [États-Unis] ; Moataz Ellithi [États-Unis] ; Rakshya Sharma [États-Unis] ; Arwyn Cunningham [États-Unis] ; Hamza Tantoush [États-Unis]Source :
- Journal of Investigative Medicine High Impact Case Reports [ 2324-7096 ] ; 2019.
Abstract
Url:
DOI: 10.1177/2324709619836139
PubMed: 30938179
PubMed Central: 6446437
Affiliations:
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Sudden Development of Multi-Organ Lesions in a Patient With Pulmonary Sarcoidosis: A Case Report</title>
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<author><name sortKey="Tantoush, Hamza" sort="Tantoush, Hamza" uniqKey="Tantoush H" first="Hamza" last="Tantoush">Hamza Tantoush</name>
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<front><div type="abstract" xml:lang="en"><p><italic>Introduction</italic>
. Sarcoidosis is a systemic granulomatous inflammatory disease that can involve almost any organ system in the human body. It most frequently presents with pulmonary infiltrates, hilar lymphadenopathy, and skin lesions. Clinical and subclinical involvement of other organ systems is not uncommon. However, the simultaneous development of clinically apparent multisystem sarcoidosis is very rare. <italic>Case Description</italic>
. This 44-year-old Caucasian man presented to an outpatient clinic with a 2-month history of fatigue, night sweats, weight loss, loss of appetite, and mild abdominal discomfort. Initial laboratory finding showed elevated liver enzymes. Imaging studies revealed cirrhotic liver with steatosis, few enhancing hepatic masses, and multiple enlarged periaortic and portocaval lymph nodes. Liver biopsy revealed scattered necrotizing granulomatous hepatitis. Positron emission tomography scan showed extensive hepatic uptake, diffuse lymphadenopathy, as well as numerous fluorodeoxyglucose-avid osseous lesions. After extensive workup to rule out malignancy and infectious etiologies, a diagnosis of diffuse multi-organ sarcoidosis was made. He was ultimately treated with methotrexate and steroids, resulting in marked improvement in symptoms and liver function, with stable disease on repeat imaging. <italic>Conclusion</italic>
. Diffuse multi-organ sarcoidosis is often associated with widespread lymphadenopathy and osseous lesions, which appear indistinguishable from malignancy on imaging. The angiotensin converting enzyme levels and inflammatory markers may be normal. Clinicians should be aware of the possibility of diffuse systemic sarcoidosis in any patient with a remote sarcoidosis history and the simultaneous development of multi-organ–related symptoms.</p>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Investig Med High Impact Case Rep</journal-id>
<journal-id journal-id-type="iso-abbrev">J Investig Med High Impact Case Rep</journal-id>
<journal-id journal-id-type="publisher-id">HIC</journal-id>
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<journal-title-group><journal-title>Journal of Investigative Medicine High Impact Case Reports</journal-title>
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<issn pub-type="epub">2324-7096</issn>
<publisher><publisher-name>SAGE Publications</publisher-name>
<publisher-loc>Sage CA: Los Angeles, CA</publisher-loc>
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<article-id pub-id-type="doi">10.1177/2324709619836139</article-id>
<article-id pub-id-type="publisher-id">10.1177_2324709619836139</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group><article-title>The Sudden Development of Multi-Organ Lesions in a Patient With Pulmonary Sarcoidosis: A Case Report</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">https://orcid.org/0000-0002-1038-6512</contrib-id>
<name><surname>Abdallah</surname>
<given-names>Mohamed A.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1-2324709619836139">1</xref>
<xref ref-type="corresp" rid="corresp1-2324709619836139"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ellithi</surname>
<given-names>Moataz</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1-2324709619836139">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sharma</surname>
<given-names>Rakshya</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1-2324709619836139">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cunningham</surname>
<given-names>Arwyn</given-names>
</name>
<degrees>DO</degrees>
<xref ref-type="aff" rid="aff1-2324709619836139">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tantoush</surname>
<given-names>Hamza</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1-2324709619836139">1</xref>
</contrib>
</contrib-group>
<aff id="aff1-2324709619836139"><label>1</label>
University of South Dakota, Sioux Falls, SD, USA</aff>
<author-notes><corresp id="corresp1-2324709619836139">Mohamed A. Abdallah, MD, Department of Medicine, University of South Dakota Sanford School of Medicine, 1400 West 22nd Street, Sioux Falls, SD 57105, USA. Email: <email>Mohamed.abdallah@usd.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>02</day>
<month>4</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="collection"><season>Jan-Dec</season>
<year>2019</year>
</pub-date>
<volume>7</volume>
<elocation-id>2324709619836139</elocation-id>
<history><date date-type="received"><day>20</day>
<month>12</month>
<year>2018</year>
</date>
<date date-type="rev-recd"><day>7</day>
<month>2</month>
<year>2019</year>
</date>
<date date-type="accepted"><day>9</day>
<month>2</month>
<year>2019</year>
</date>
</history>
<permissions><copyright-statement>© 2019 American Federation for Medical Research</copyright-statement>
<copyright-year>2019</copyright-year>
<copyright-holder content-type="society">American Federation for Medical Research</copyright-holder>
<license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This article is distributed under the terms of the Creative Commons Attribution 4.0 License (<ext-link ext-link-type="uri" xlink:href="http://www.creativecommons.org/licenses/by/4.0/">http://www.creativecommons.org/licenses/by/4.0/</ext-link>
) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (<ext-link ext-link-type="uri" xlink:href="https://us.sagepub.com/en-us/nam/open-access-at-sage">https://us.sagepub.com/en-us/nam/open-access-at-sage</ext-link>
).</license-p>
</license>
</permissions>
<abstract><p><italic>Introduction</italic>
. Sarcoidosis is a systemic granulomatous inflammatory disease that can involve almost any organ system in the human body. It most frequently presents with pulmonary infiltrates, hilar lymphadenopathy, and skin lesions. Clinical and subclinical involvement of other organ systems is not uncommon. However, the simultaneous development of clinically apparent multisystem sarcoidosis is very rare. <italic>Case Description</italic>
. This 44-year-old Caucasian man presented to an outpatient clinic with a 2-month history of fatigue, night sweats, weight loss, loss of appetite, and mild abdominal discomfort. Initial laboratory finding showed elevated liver enzymes. Imaging studies revealed cirrhotic liver with steatosis, few enhancing hepatic masses, and multiple enlarged periaortic and portocaval lymph nodes. Liver biopsy revealed scattered necrotizing granulomatous hepatitis. Positron emission tomography scan showed extensive hepatic uptake, diffuse lymphadenopathy, as well as numerous fluorodeoxyglucose-avid osseous lesions. After extensive workup to rule out malignancy and infectious etiologies, a diagnosis of diffuse multi-organ sarcoidosis was made. He was ultimately treated with methotrexate and steroids, resulting in marked improvement in symptoms and liver function, with stable disease on repeat imaging. <italic>Conclusion</italic>
. Diffuse multi-organ sarcoidosis is often associated with widespread lymphadenopathy and osseous lesions, which appear indistinguishable from malignancy on imaging. The angiotensin converting enzyme levels and inflammatory markers may be normal. Clinicians should be aware of the possibility of diffuse systemic sarcoidosis in any patient with a remote sarcoidosis history and the simultaneous development of multi-organ–related symptoms.</p>
</abstract>
<kwd-group><kwd>sarcoidosis</kwd>
<kwd>systemic sarcoidosis</kwd>
<kwd>granulomatous disease</kwd>
<kwd>hepatic sarcoidosis</kwd>
<kwd>bone sarcoidosis</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>cover-date</meta-name>
<meta-value>January-December 2019</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>États-Unis</li>
</country>
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<tree><country name="États-Unis"><noRegion><name sortKey="Abdallah, Mohamed A" sort="Abdallah, Mohamed A" uniqKey="Abdallah M" first="Mohamed A." last="Abdallah">Mohamed A. Abdallah</name>
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<name sortKey="Cunningham, Arwyn" sort="Cunningham, Arwyn" uniqKey="Cunningham A" first="Arwyn" last="Cunningham">Arwyn Cunningham</name>
<name sortKey="Ellithi, Moataz" sort="Ellithi, Moataz" uniqKey="Ellithi M" first="Moataz" last="Ellithi">Moataz Ellithi</name>
<name sortKey="Sharma, Rakshya" sort="Sharma, Rakshya" uniqKey="Sharma R" first="Rakshya" last="Sharma">Rakshya Sharma</name>
<name sortKey="Tantoush, Hamza" sort="Tantoush, Hamza" uniqKey="Tantoush H" first="Hamza" last="Tantoush">Hamza Tantoush</name>
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