Prevalence, clinical profile, investigations, and visual outcome of sarcoid intermediate uveitis in a tertiary eye care center in South India

Purpose: To report the prevalence, clinical profile, investigations, and visual outcomes of sarcoid intermediate uveitis in a tertiary eye care center in South India. Methods: Retrospective, observational case series. Records of 29 patients with sarcoid intermediate uveitis were retrieved. Complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done. Results were analyzed using SPSS software. Results: Mean age group was 42.14 ± 11.31 years. The bilateral presentation was more common and females were more affected than males. Anterior chamber cells and flares in 22.4% of cases (N = 11 eyes), posterior synechiae in 20.4% (N = 10 eyes), and both small and mutton fat keratic precipitates in 14.2% of cases (N = 7 eyes) were noted; only one eye had Busacca nodules similar to other granulomatous uveitis. Cystoid macular edemas were present in three eyes. Treatment with oral steroids and systemic immunosuppression resulted in good visual recovery. The mean presenting visual acuity in right and left eye were 0.2 and 0.3, respectively. The mean final visual acuity in right and left eye was 0.1 and 0.3, respectively. Conclusion: Sarcoid intermediate uveitis is quite common in a tuberculosis endemic country like India. A complete review of systems with appropriate investigations is essential to prevent visual complications

Sarcoidosis con compromiso cutáneo casuística del Servicio de Dermatología del Hospital Nacional- período 2010-2020 / Sarcoidosis with skin engagement casuistics of the National Hospital Dermatology Service - period 2010-2020

Introducción: La sarcoidosis es una enfermedad inflamatoria, granulomatosa de etiología desconocida. Puede afectar cualquier órgano siendo la afectación pulmonar la más frecuente. La piel se compromete en aproximadamente 30% de los casos, pudiendo ser inicial o único. La sarcoidosis es muy rara en el Paraguay. Objetivos: Realizar una revisión de los casos de sarcoidosis observados en el Servicio de Dermatología del Hospital Nacional en el periodo 2010-2020; determinando sus características demográficas, clínicas, laboratoriales y evolutivas. Materiales y métodos: Estudio retrospectivo, descriptivo y observacional. Resultados: Se diagnosticaron 5 casos, todas mujeres de raza blanca, con edades que oscilaban de 41 a 63 años. Las formas clínicas fueron papulosa en 3 casos, en placa 1 y mixta 1. Las lesiones cutáneas eran asintomáticas y estaban ubicadas preferentemente en rostro (4 casos). El compromiso sistémico se objetivó en las primeras consultas en 2 casos (pulmonar, ocular y ganglionar en 1 y del aparato lagrimal en otro). En todos los casos el diagnóstico se fundamentó en la correlación clínico-histológica, con el hallazgo de los granulomas sarcoides. Todos recibieron clobetasol tópico, 3 pacientes ciclos de prednisona y 2 hidroxicloroquina. La evolución fue favorable en 3 casos y 2 no volvieron a sus controles. Conclusión: La sarcoidosis con manifestaciones cutáneas es rara en nuestro Servicio, pero representa un desafío diagnóstico, que debe ser oportuno para diferenciarla de otras patologías más prevalentes en nuestro medio

Introduction: Sarcoidosis is an inflammatory, granulomatous disease of unknown etiology. It can affect any organ, lung involvement being the most frequent. The skin is compromised in approximately 30% of the cases, and can be initial or unique. Sarcoidosis is very rare in Paraguay. Objectives: To carry out a review of the sarcoidosis cases observed in the Dermatology Service of the National Hospital in the period 2010-2020; determining their demographic, clinical, laboratory and evolutionary characteristics. Materials and methods: Retrospective, descriptive and observational study. Results: 5 cases were diagnosed; all white women; with ages ranging from 41 to 63 years. The clinical forms were papular in 3 cases, in plate 1 and mixed 1. The skin lesions were asymptomatic and were preferably located on the face (4 cases). Systemic involvement was observed in the first consultations in 2 cases (pulmonary, ocular and lymph node in 1 and the lacrimal apparatus in another). In all cases the diagnosis was based on the clinical-histological correlation, with the finding of sarcoid granulomas. All received topical clobetasol, 3 patients received prednisone cycles and 2 hydroxychloroquine. The evolution was favorable in 3 cases and 2 did not return to their controls. Conclusion: Sarcoidosis with skin manifestations is rare in our Service, but it represents a diagnostic challenge that must be timely to differentiate it from other more prevalent pathologies in our setting

Sarcoid-like granulomatous myositis-associated hypercalcemia. An infrequent case to consider / Hipercalcemia asociada a miositis granulomatosa sarcoidea simil- sarcoidea. Un caso infrecuente a considerar

Abstract PTH-independent hypercalcemia due to granulomatous disease is well-documented and sarcoidosis is the most characteristic disease, although there are others. We describe a case of sarcoid-like granulomatous myositis. An 87-year-old man was referred with tetraparesis and hypercalcemia (albumin-corrected calcium of 13.4 mg/dl) following a trip to the Caribbean. The evaluation showed a suppressed PTH, 25-hydroxy vitamin D of 7.5 ng/ml, 18F-FDG PET/CT showed markedly increased uptake in intercostal, back, shoulder, but tock and thigh muscles and a deltoid biopsy confirmed extensive granulomatous myositis. He was prescribed glucocorticoids which resulted in normalized plasma calcium levels and complete recovery from tetraparesis. Sarcoid-like granulomatous myositis should be incorporated into the differential diagnosis of PTH-independent hypercalcemia, especially in the absence of clinical features of sarcoidosis and with special emphasis on the use of 18F-FDG PET/CT to ensure a correct approach.

Resumen La hipercalcemia PTH-independiente asociada a enfermedades granulomatosas está bien documentada y la sarcoidosis es la enfermedad más característica, a pesar de que existen otras. Des cribimos un caso de miositis granulomatosa simil-sarcoidea. Un hombre de 87 años consultó por tetraparesia e hipercalcemia (calcio corregido por albúmina 13.4 mg/dl) luego de un viaje al Caribe. La evaluación mostró una PTH suprimida, 25-hidroxivitamina D 7.5 ng/ml, 18F-FDG PET/CT mostró marcado aumento de captación a nivel de musculatura intercostal, dorsal, deltoidea, glúteos y muslos. Una biopsia deltoidea confirmó una miositis granulomatosa extensa. Se prescribieron glucocorticoides, resultando en normalización del calcio plasmático y completa recuperación de la tetraparesia. La miositis granulomatosa simil-sarcoidea debe ser incorporada den tro del diagnóstico diferencial de la hipercalcemia PTH-independiente, especialmente en ausencia de hallazgos clínicos de sarcoidosis y con especial énfasis en el uso de 18F-FDG PET/CT para su correcta aproximación.

Subcutaneous Sarcoidosis (Darier Roussy Sarcoid): A Rare Entity of Cutaneous Sarcoidosis

Summary@#Sarcoidosis is a multisystem disease characterised by granulomatous inflammation possibly due to hyperactivation of the immune system; with unknown etiology. Subcutaneous sarcoidosis (also known as Darier Roussy sarcoid) is a rare type of specific cutaneous lesion of sarcoidosis characterised by multiple firm, asymptomatic to mildly tender, mobile, round to oval, and skin coloured nodules. Herein we report a rare case of subcutaneous sarcoidosis.

Síndrome sarcoidosis-linfoma. Presentación de 2 casos clínicos / Sarcoidosis-lymphoma syndrome. Presentation of 2 clinical cases

RESUMEN La combinación de sarcoidosis y linfoma (síndrome sarcoidosis-linfoma) es una asociación poco frecuente pero reconocida en el ámbito clínico. Algunas manifestaciones pueden ser comunes entre estas entidades, por lo que es un reto para el clínico diferenciar cada enfermedad por separado o si coexisten en un mismo individuo. En este último escenario, ni las manifestaciones clínicas ni los parámetros de laboratorio son específicos, por lo que es necesario un análisis minucioso de cada caso, apoyado de laboratorios, imágenes e histopatología para llegar a un diagnóstico certero. Se presentan 2 casos de síndrome sarcoidosis-linfoma y se analizan los aspectos clave en el diagnóstico de esta forma clínica.

ABSTRACT The combination of sarcoidosis and lymphoma (sarcoidosis-lymphoma syndrome) is a rare but recognised clinical condition. Some manifestations may be common among these conditions, making it a challenge for the clinician to differentiate each disease separately, or if they coexist in the same individual. In this latter scenario, neither the clinical manifestations nor the laboratory parameters are specific, so a meticulous analysis of each case is necessary, supported by laboratory and imaging tests, and histopathology in order to obtain an accurate diagnosis. Two cases of sarcoidosis-lymphoma syndrome are presented, and an analysis is presented on the key aspects in the diagnosis of this clinical condition.

Sarcoide equino: revisión y actualización / Equine sarcoid: a review and Update / Sarcoide eqüino: revisão e atualização

Resumen El sarcoide equino es la neoplasia más común de los équidos y representa más de la mitad de las neoplasias de la piel de los caballos. El objetivo del presente trabajo fue realizar una compilación del conocimiento actual sobre etiología, fisiopatología, diagnóstico y tratamiento de esta patología. El agente etiológico del sarcoide equino es el virus del papiloma bovino tipo 1 y 2 que afecta a équidos de todas las razas, sexos y edades. El traumacutáneo, la presencia de vectores como insectos y algunos haplotipos genéticos son potenciales factores de riego. Se diagnostica a partir de la apariencia clínica, clasificándose en 6 tipos diferentes. La confirmación del diagnóstico se realiza mediante histopatología y las alternativas terapéuticas disponibles son muy variadas incluyendo cirugía, quimioterapia, radioterapia, inmunoterapia y otras. En conclusión, ésta es una patología de curso impredecible, no existiendo tratamiento efectivo por sí solo, ya que existe una alta probabilidad de recurrencia y solo el empleo de nuevas modalidades terapéuticas combinadas permite obtener mejores resultados. La prevención probablemente se verá facilitada en el futuro por el desarrollo de vacunas contra el virus del papiloma bovino.

Abstract The equine sarcoid is the most common neoplasm of equidae and represents more than half of the skin neoplasms of horses. The objective of the present work was to make a compilation of current knowledge about etiology, pathophysiology, diagnosis and treatment of this pathology. The etiological agent of the equine sarcoid is the bovine papilloma virus type 1 and 2 which affects equines of all races, sexes and ages. Cutaneous trauma, the presence of vectors such as insects and some genetic haplotypes are potential risk factors. It is diagnosed from the clinical appearance, classified into 6 different types. The confirmation of the diagnosis is made by histopathology and the therapeutic alternatives available are very varied, including surgery, chemotherapy, radiotherapy, immunotherapy and others. In conclusion, this is a pathology of unpredictable course, there is no effective treatment by itself, since there is a high probability of recurrence and only the use of new combined therapeutic modalities allows to obtain better results. Prevention will likely be facilitated in the future by the development of vaccines against the bovine papilloma virus.

Resumo O sarcoide eqüino é a neoplasia mais comum dos equídeos e representa mais da metade das neoplasias de pele dos equinos. O objetivo do presente trabalho foi fazer uma compilação dos conhecimentos atuais sobre etiologia, fisiopatologia, diagnóstico e tratamento desta patologia. O agente etiológico do sarcoide eqüino é o papilomavírus bovino tipo 1 e 2, que afeta equinos de todas as raças, sexos e idades. Trauma cutâneo, a presença de vetores como insetos e alguns haplótipos genéticos são fatores de risco potenciais. É diagnosticado a partir da aparência clínica, classificada em 6 tipos diferentes. A confirmação do diagnóstico é feita pela histopatologia e as alternativas terapêuticas disponíveis são muito variadas, incluindo cirurgia, quimioterapia, radioterapia, imunoterapia e outras. Em conclusão, esta é uma patologia de curso imprevisível, não há tratamento efetivo por si só, uma vez que há uma alta probabilidade de recorrência e apenas o uso de novas modalidades terapêuticas combinadas permite obter melhores resultados. A prevenção provavelmente será facilitada no futuro pelo desenvolvimento de vacinas contra o vírus do papiloma bovino.

Sarcoidosis detected due to tattoo swellings in an Indian female.

A female patient presented with asymptomatic swellings in old blue-black tattoo marks of her forearms. On careful skin examination, few raised erythematous, circular plaques were also found on the non-tattooed skin on her back, about which she was unaware. The diagnosis of cutaneous and systemic sarcoidosis was confi rmed after classical histopathological fi ndings from skin lesions from her non tattooed back and from papulonodular tattooed lesions, ruling out other causes of granulomas and supported by a negative Mantoux test, raised serum angiotensin converting enzyme level, high resolution computed tomography thorax, etc. She responded well to oral steroid therapy. The importance of a careful skin examination, easy access provided by skin lesions in suspected cases of cutaneous/systemic sarcoidosis, the value of sudden tattoo changes in the diagnosis here and the possible contribution of tattoos toward the causation of cutaneous and/or systemic sarcoidosis are highlighted.

Equine dermatopathies in southern Brazil: a study of 710 cases / Dermatopatias em equinos na região sul do Rio Grande do Sul: estudo de 710 casos

A retrospective study of equine skin diseases diagnosed in the Laboratório Regional de Diagnóstico, Faculdade de Veterinária, Universidade Federal de Pelotas was conducted between 1978 and 2013. The necropsy and biopsy protocols for horses received for diagnosis were reviewed to determine the prevalence of dermatopathies in southern Brazil. The most prevalent skin diseases in decreasing order were: sarcoid [234/710 (32.9%)], exuberant granulation tissue [81/710 (11.4%)], pythiosis [67/710 (9.4%)], squamous cell carcinoma [55/710 (7.7%)], papillomatosis [33/710 (4.6%)] and habronemiasis [30/710 (4.2%)]. Other skin lesions accounted for 25.3% of all cases studied. The Crioulo breed was the most prevalent [310/710 (43.6%)]. Horses aged between 2-5 years old [230/710 (32.3%)] were the most frequently affected. The data obtained in this study demonstrate the importance of skin diseases that affect horses in southern Brazil. The most of the dermatopathies observed in horses, although not resulting in death could cause aesthetic damage resulting in animal rejection, the inability to participate in collective sports activities and economic losses due to treatment and surgery costs.

Realizou-se estudo retrospectivo das doenças de pele observadas em equinos no Laboratório Regional de Diagnóstico da Faculdade de Veterinária da Universidade Federal de Pelotas, entre 1978 e 2013, com o objetivo de determinar a prevalência das dermatopatias que ocorrem em equinos na região sul do Rio Grande do Sul. As doenças de pele mais prevalentes em ordem decrescente foram: sarcoide [234/710 (32,96%)], tecido de granulação exuberante [81/710 (11,4%)], pitiose [67/710 (9,4%)], carcinoma de células escamosas [55/710 (7,7%)], papilomatose [33/710 (4,6%)] e habronemose [30/710 (4,2%)]. As outras doenças de pele juntas corresponderam a 25,3% de todos os casos estudados. A raça Crioula foi a mais acometida [310/710 (43,6%)]. Os animais mais afetados tinham entre 2-5 anos de idade [230/710 (32,3%)]. Com os dados obtidos, foi demonstrada a importância das dermatopatias que afetam equinos na região sul do Rio Grande do Sul. A maioria das enfermidades cutâneas diagnosticadas, apesar de não causar a morte dos animais, compromete a estética que impossibilita a participação em feiras/exposições, além de causar perdas econômicas com gastos com tratamentos e cirurgias.

The Immune Paradox of Sarcoidosis: A Review of Literature.

This review briefly summarises the literature concerning our current understanding of the aetiology and immunopathogenesis of sarcoidosis, and the identification of novel markers of this disease. Although the immune paradox is a key part of sarcoid immunology, the mechanisms underlying this remarkable phenomenon are not well understood. Biomarkers may further the current understanding of the granulomatous inflammation seen in sarcoidosis. Exhaled breath condensate (EBC) is a novel, minimally invasive tool to sample the fluid lining the respiratory tract. EBC can be used to identify sarcoid specific biomarkers, which may shed light on the sarcoid immune paradox.

Estudo retrospectivo das neoplasias em ruminantes e equídeos no semiárido do Nordeste Brasileiro / Retrospective study of tumors in ruminants and horses in semiarid Northeast of Brazil

In Brazil, data related to occurrence of tumors in livestock are scarce. The objective of this study was to determine the frequency of tumors diagnosed in equidae, cattle, sheep and goats in the Pathology Laboratory of the Federal University of Campina Grande, Patos, state of Paraíba, from 1983 to 2010, and to analyze the risk factors by the chi square test, considering variables such as species, breed, age and sex. During the period, 177 (5.6%) out of 3153 specimens from biopsies or necropsies were diagnosed as tumors. There were significant differences (p<0.001) in the frequency of tumors among different species; horses (10.6%) were more affected than cattle (6.8%), and cattle were more affected than goats (3.3%) and sheep (2.1%). Squamous cell carcinoma was most frequent tumor in cattle (58.3% of the tumors), sheep (80%) and goats (46.1%), and sarcoid (45.3%) was the most frequent in horses. Regarding the location, neoplasms were more common in the skin of horses (62.5%) and sheep (60%), in the eyes and periocular skin in cattle (36.1%), and un the female reproductive system (perineal region and vulva) of goats (34.6%). Regarding the sex of the animals, only cattle had significant prevalence (p<0.001). Regarding age only goats showed significant prevalence (p=0.015). There was no significant prevalence in any animal species in relation to race. We concluded that squamous cell carcinomas in ruminants and equine sarcoid are the most common tumors in livestock in the semiarid Brazilian Northeast, and the equidae were the most affected among the species studied.

No Brasil, dados relacionados com a ocorrência de neoplasias em ruminantes e equinos são escassos. Objetivou-se com este trabalho determinar a frequência de neoplasias diagnosticadas em bovinos, caprinos, ovinos e equídeos no Laboratório de Patologia Animal da Universidade Federal de Campina Grande, Patos, Paraíba, durante o período de 1983 a 2010 e analisar os fatores de risco, mediante o teste de qui-quadrado, considerando como variáveis, espécie, raça, sexo e idade. Durante o período foram registrados 177 (5,6%) tumores de um total de 3.153 diagnósticos provenientes de biópsias e necropsias. Houve diferenças significantes (p<0,001) na frequência de tumores entre as diferentes espécies sendo mais acometidos os equinos (10,6%), seguidos pelos bovinos (6,8%), caprinos (3,3%) e ovinos (2,1%). Os tumores mais frequentes foram o carcinoma células escamosas (CCE) nos bovinos (58,3%), ovinos (80%) e caprinos (46,1%) e o sarcoide em equinos (45,3%). Quanto à localização anatômica, as neoplasias foram mais frequentes na pele em equídeos (62,5%) e ovinos (60%), olho e tecido periocular em bovinos (36,1%) e sistema reprodutor feminino (períneo e vulva) em caprinos (34,6%). Em relação ao sexo dos animais, apenas os bovinos apresentaram prevalência significativa (p<0,001). Em relação à idade apenas os caprinos apresentaram prevalência significativa (p=0,015). Não houve prevalência significativa em nenhuma espécie em relação à raça. Conclui-se que os carcinomas de células escamosas em ruminantes e o sarcoide em equídeos são os tumores mais frequentes em animais de produção no semiárido do Nordeste Brasileiro e que a espécie equina foi a mais acometida dentre as espécies estudadas.

Sarcoide equino fibroblástico periocular en un burro (Eqqus asinus) / Periocular fibroblastic sarcoid in a donkey (Equus asinus ) / Sarcóide equino fibroblástico periocular em um burro (Eqqus asinus)

En el presente estudio se describen y discuten los signos clínicos, lesiones macro y microscópicas, epidemiología y el método diagnóstico de un caso de Sarcoide Fibroblastico Periocular en burros (Equus asinus) en el departamento de Córdoba (Colombia). El animal presentó múltiples masas nodulares en la parte superior e inferior de los párpados y el ángulo ocular medial del lado izquierdo, con discreta ulceración y levantamiento difuso de la piel, caracterizadas por una apariencia tumoral, granulomatosa, de consistencia firme y fibrosa. Los hallazgos histopatológicos mostraron hiperplasia epidérmica, hiperqueratosis, largas proyecciones epiteliales en dirección a la dermis y orientación perpendicular de los fibroblastos en relación a la membrana basal. El diagnóstico se fundamentó en las características clínicas, epidemiológicas, y en los hallazgos histopatológicos.

In the present study we describe and discuss the clinical signs, gross and microscopic lesions, epidemiology, and diagnosis of a periocular fibroblastic sarcoid case in a donkey (Equus asinus) in Cordoba province (Colombia). The animal presented multiple nodular masses in the upper and lower eyelids and the medial angle of the left eye, with slight ulceration and diffuse skin lifting, characterized by tumor-like appearance, granulomatous, firm, and fibrous. Histopathological findings included epidermal hyperplasia, hyperkeratosis, long epithelial projections toward the dermis, and perpendicular orientation of fibroblasts relative to the basal membrane. The diagnosis was based on the clinical, epidemiological, and pathological findings.

Este estudo pretende descrever e discutir os signos clínicos, as lesões macro e microscópicas, a epidemiologia e o método diagnostico num caso de Sarcoide Fibroblastico Periocular num jumento (Eqqus asinus), no departamento de Córdoba, no noroeste da Colômbia. Ao abordar o caso clínico, observaram-se múltiplas massas nodulares na parte superior e inferior das pálpebras e no ângulo ocular medial do lado esquerdo, com uma discreta ulceração e levantamento difuso da pele caracterizado por uma aparência tumoral, granulomatosa, de consistência firme e fibrosa. Os encontros histopatológicos demonstraram hiperplasia epidérmica, hiperqueratose, projeções epiteliais longas em direção à derme e orientação perpendicular dos fibroblastos em relação à membrana basal. O diagnostico fundamentou-se nas características clínicas, epidemiológicas e nos encontros histopatológicos.

Ocorrência de neoplasias em 15 anos de atendimento hospitalar de equídeos / A survey on equine neoplasias over a 15-year period in a veterinary hospital

na distribuição, em decorrência de diferenças regionais, como clima e população racial. Foram analisados 133 casos de neoplasias dentre os 6669 equídeos atendidos no Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, durante um período de 15 anos, representando 2% do total de atendimentos. A neoplasia mais frequente foi o carcinoma de células escamosas (45%), diferindo da maioria dos estudos realizados mundialmente. No sistema tegumentar, a neoplasia mais comum foi o melanoma (34,2%); nos sistemas ocular e urogenital, foi o carcinoma de células escamosas (76,9% e 40,9% respectivamente). Em 68% dos casos foi realizado tratamento cirúrgico, em 10%, tratamento clínico e em 22%, nenhum tipo de tratamento, por opção do proprietário ou indicação de eutanásia. Óbitos por causas relacionadas às neoplasias ocorreram em 14% dos casos. Os achados sugerem que o carcinoma de células escamosas ocorre mais frequentemente em nosso atendimento hospitalar. Este fato pode estar relacionado à exposição prolongada à luz ultravioleta, cuja quantidade de radiação em regiões tropicais vem aumentando consideravelmente nas últimas décadas.

Although several prior studies have provided information regarding incidence of tumors in horses, there is a wide variation due to regional differences, such as climate and breed population. A number of 133 cases involving tumors was found among the 6669 equides submitted to the Veterinary Hospital (HOVET) of the School of Veterinary Medicine of the University of São Paulo, during a 15 years period, representing 2% of all records. The most commonly found neoplasm was the squamous cells carcinoma (45%), different from most of the studies worldwide. The most common neoplasia in the integument system was melanoma (34,2%) and in the ocular (76,9%) and urogenital systems (40,9%) was squamous cells carcinoma. Surgical intervention was recommended in 68% of the cases, while a clinical approach was chosen in 10% of them. Twenty two percent of the horses were not treated due to of the owner option or euthanasia indication. Death associated with tumors occurred on 14% of the animals during the hospitalization period or treatment. The squamous cell carcinoma occurs more often in our veterinary hospital and may be related to prolonged exposure to ultraviolet radiation, whose amount in the tropics has increased considerably in the last decades.

Cutaneous Granulomas Associated with Common Variable Immunodeficiency / 대한피부과학회지

Common variable immunodeficiency (CVID) is one of the primary immunodeficiency disorders, which is characterized by hypogammaglobulinemia, defect in antibody synthesis and recurrent sinorespiratory bacterial infections. Granuloma is an uncommon skin manifestation in primary immunodeficiency disorders. Here we present a 5-year-old girl who had asymptomatic erythematous plaques on the face and legs. She had a past medical history of recurrent sinorespiratory and gastrointestical bacterial infections since 2 years old. The histopathologic findings of the skin lesions showed sarcoid-like granulomas with focal necrobiosis. No specific organism was found with evaluation. Cells forming granulomas were strongly positive for CD3 or CD68. CD4/CD8 ratio was estimated less than 1. Laboratory examination showed low hemoglobin, low B cell and normal T cell number, low IgA and IgG levels.

Aspectos epidemiológicos e distribuição anatômica das diferentes formas clínicas do sarcoide equino no Rio Grande do Sul: 40 casos / Epidemiological aspects and anatomic distribuition of equine sarcoid in the state of Rio Grande do Sul, Brazil: 40 cases

The files of histopathological exams carried out by the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM), between January 2000 and March 2010, were reviewed in search of cases of equine sarcoid. Forty cases were selected to determine epidemiological aspects and anatomical distribution of the various clinical forms of these neoplasms in horses from Rio Grande do Sul. Out of the cases in which the ages were registered in the histopathological reports, 73.0 percent (27/37) were 1 to 5-year-old horses. Multiple sarcoids were observed in most of the affected horses (29/40 [72.5 percent]). The fibroblastic form was most frequently observed and occurred in 42.2 percent (27/64) of the cases. In more than half of the cases (22/40 [55.0 percent]), sarcoids had a multifocal distribution. Twenty two (55 percent) out of the 40 horses evaluated had the tumors in the limbs.

Foram revisados todos os protocolos de exames histopatológicos, arquivados no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM), realizados entre janeiro de 2000 e março de 2010, na busca de casos de sarcoide equino. Quarenta casos foram selecionados com o objetivo de determinar os aspectos epidemiológicos e a distribuição anatômica das diferentes formas clínicas deste tumor em equinos no Rio Grande do Sul. Dos casos que tiveram suas idades anotadas nos protocolos, 73,0 por cento (27/37) eram de equinos entre 1 e 5 anos de idade. Múltiplos sarcoides foram observados na maioria dos equinos afetados (29/40 [72,5 por cento]). A forma clínica mais observada foi a fibroblástica, que ocorreu em 42,2 por cento (27/64) dos casos. Em mais da metade dos casos (22/40 [55,0 por cento]), os sarcoides tinham distribuição multifocal. Equinos que apresentavam tumores nos membros totalizaram 22 dos 40 (55 por cento) casos analisados.

Mortimer's Malady revisited: A case of polymorphic cutaneous and systemic sarcoidosis.

Sarcoidosis is a systemic disorder with prominent cutaneous component. Skin lesions are of diverse morphology, of which few are specific for the disease. We describe a 30-year-old woman with polymorphic skin lesions including papules, plaques, and nodules, as well as uncommon variants like eyelid papules, palmar and digital nodules, tattoo sarcoid, as well as scar sarcoid. The patient also had stage II pulmonary sarcoidosis, and articular as well as reticulo-endothelial system involvement manifested by enlarged mediastinal and abdominal lymph nodes and hepatosplenomegaly. The presentation of polymorphic skin lesions with involvement of multiple extra-cutaneous systems is uncommon in a single patient.

Sarcoide equino associado ao papilomavírus bovino BR-UEL-4 / Equine sarcoid associated with bovine papillomavirus BR-UEL-4

Um equino, sem raça definida, macho com três anos de idade apresentou múltiplos nódulos na pele, em diversas regiões do corpo. As lesões localizavam-se predominantemente nos lábios, nas bochechas, na região submandibular e na região inguinal direita. Os tumores caracterizavam-se como sarcoides dos tipos misto, fibroblástico, verrucoso e oculto. Histologicamente apresentaram proliferação de fibroblastos dérmicos, muitas vezes ulcerado, com ou sem hiperplasia pseudoepiteliomatosa da epiderme e formação de pequenos grupos isolados de fibroblastos neoplásicos na derme superficial. Três amostras de tecido foram submetidas à extração de DNA e amplificação por PCR com oligonucleotídeos iniciadores genéricos direcionados para uma região interna do gene L1 dos papilomavírus. Os produtos resultantes da amplificação de duas amostras foram sequenciados e demonstraram identidade de 99 por cento com o papilomavírus bovino (BPV) BR-UEL-4. Essa é a primeira descrição da infecção de equinos, bem como de sua associação com sarcoide pelo BPV BR-UEL-4, um suposto novo tipo de BPV identificado recentemente no Brasil a partir de papilomas cutâneos em bovinos.

A 3-year-old, mixed breed, male horse showed multiple nodules in different areas of the skin. Lesions occurred predominantly on the lips, cheeks, and submandibular and right inguinal regions. The nodules were characterized as mixed, fibroblastic, verrucous and occult types of sarcoid. Histologically there was proliferation of dermal fibroblasts, with or without pseudoepitheliomatous hyperplasia of the epidermis (frequently ulcerated), and formation of small isolated groups of neoplastic fibroblasts in the superficial dermis. Three tissue samples were submitted to DNA extraction and PCR amplification with generic primers for the internal region of the papillomavirus L1 gene. The amplified products from two samples were sequenced and showed 99 percent identity with the bovine papillomavirus (BPV) BR-UEL-4. This is the first description of BPV BR-UEL-4 infecting a horse and causing sarcoid in this species. BPV BR-UEL-4 is a putative new BPV type recently identified in skin papillomas in a Brazilian cattle herd.

A rare case of sarcoid-like reaction of lymph nodes associated with squamous cell carcinoma of alveolar mucosa.

Non-necrotizing granulomas are occasionally seen in patients with certain malignant disorders and are termed as "sarcoid-like reaction," which have many similarities with sarcoidosis. Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by organ involvement and interference of organ function by granuloma or fibrosis. Sarcoidosis is occasionally found in a variety of malignant diseases with an overall incidence of 4.4% in carcinoma patients. We present here a rare case of moderately differentiated squamous cell carcinoma of alveolar mucosa with regard to mandible associated with sarcoid-like reaction of cervical lymph nodes in a female patient in the absence of clinical evidence of systemic sarcoidosis. The relevant literature including pathogenesis is also discussed.

Paracoccidioidomycosis: infiltrated, sarcoid-like cutaneous lesions misinterpreted as tuberculoid leprosy / Paracoccidioidomicose: lesões cutâneas, infiltrativas, sarcoidose-símile, diagnosticadas como hanseníase tuberculóide

The authors report a case of paracoccidioidomycosis misinterpreted as tuberculoid leprosy, both on clinical and histological examination. Sarcoid-like cutaneous lesion as the initial presentation is rare in young patient with paracoccidioidomycosis and can simulate other infectious or inflammatory diseases. On histology, tuberculoid granuloma presented similar difficulties. Treatment with dapsone, a sulfonamide derivative, could have delayed the presumed natural clinical course to the classical juvenile type of paracoccidioidomycosis, observed only 24 months after the patient had been treated for leprosy.

Os Autores relatam um caso de paracoccidioidomicose diagnosticado como se fora hanseníase tuberculóide, tanto do ponto de vista clínico como histopatológico. Lesão cutânea de padrão sarcoídico é raramente observada como lesão inicial da paracoccidioidomicose em jovens e pode simular outras dermatoses infecciosas ou inflamatórias. O achado histológico de granuloma tuberculóide apresenta dificuldade diagnóstica similar. O tratamento realizado com dapsone, um derivado sulfamídico, pode ter retardado a evolução clínica esperada para o padrão clássico da paracoccidioidomicose tipo juvenil, o qual apenas se materializou 24 meses após a paciente ter iniciado tratamento como hanseníase.

Clinical Features in Korean Patients with Sarcoid Uveitis

PURPOSE: To investigate the clinical features of Korean patients with sarcoid uveitis. METHODS: The medical records of patients with endogenous uveitis who were recruited from the uveitis clinic at Seoul National University Hospital were reviewed. Sex, age at presentation, ocular symptoms and signs, treatment, complications, and the rate of recurrence were analyzed. RESULTS: Of 440 patients with endogenous uveitis, 31 (7.1%) with sarcoidosis were included. The mean age at onset was 54.5 years. Sarcoidosis patients with uveitis tended to be older than those without uveitis (44.1 years). Uveitis was the primary manifestation of sarcoidosis in 16 of 31 patients (51.6%). Anterior uveitis was the most common in terms of the anatomic location of inflammation (54.8%), and posterior involvement (38.7%) was not rare. Systemic corticosteroid therapy was administered to 28 patients (90.3%). Five patients (16.1%) received corticosteroids combined with immunosuppressive agents. CONCLUSIONS: Sarcoid uveitis is not a rare etiology of endogenous uveitis. Topical or systemic corticosteroids could control inflammation in most cases, but immunosuppressive agents are needed in a small percentage of patients. Steroids combined with immunosuppressive agents can prevent severe visual losses in such patients.

A Case of Sarecoid Dactylitis / 대한피부과학회지

We report a case of sarcoid dactylitis in which there have been significant bone changes. A 46 year-old female presented with digital erythematous clubbing-like changes and sausage-like swellings of middle phalanges of both hands for 3 months. She had also several freely movable nontender subcutaneous nodules on her trunk and extremities for 3 years. There was a mild leukopenia and decreased cell-mediated immunity. The chest X-ray revealed bilateral hilar lymphadenopathy with increased interstitial lung markings. The X-ray of the hands and feet revealed paraarticular osteolytic lesions and altered trabecular patterns. Histopathologically there were several well-circumscribed granulomas without any caseating necrosis. We treated her with oral prednisone and hydroxychloroquine with some improvement.