Cutaneous sarcoidosis: clinico-epidemiological profile of 72 patients at a tertiary hospital in São Paulo, Brazil,

Abstract Background: Sarcoidosis is a multisystem disease of unknown cause that is characterized by the presence of granulomas in various organs. Cutaneous involvement is common and the reported incidence has varied from 9% to 37%. Studies on cutaneous sarcoidosis in Brazil are lacking. Objectives: To describe the clinical and epidemiological aspects of patients with cutaneous sarcoidosis diagnosed at the Department of Dermatology of the University of São Paulo, from May 1994 to March 2018. Methods: Clinical data of patients with confirmed cutaneous sarcoidosis were retrospectively reviewed and classified according to gender, ethnicity, age at diagnosis, cutaneous presentation, systemic involvement and treatment. Results: Cutaneous sarcoidosis was diagnosed in 72 patients with a female predominance (74%). The mean age at diagnosis was 49.6 years and most of the patients were white (61%). Papules and plaques were the most common lesions. Systemic sarcoidosis was detected in 81% of patients, affecting mainly the lungs and thoracic lymph nodes (97%). Typically, cutaneous lesions were the first manifestation (74%). Systemic therapy was necessary for 72% of patients; the dermatologist managed many of these cases. Oral glucocorticoids were the most commonly used systemic medication (92%). The mean number of systemic drugs used was 1.98 per patient. Limitations: Insufficient data in medical records. Conclusions: This series highlights the dermatologist role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement and treating the skin manifestations. Cutaneous sarcoidosis was once considered exceedingly infrequent in Brazil in comparison to infectious granulomatous diseases; however, the present series seems to suggest that the disease is not so rare in this region.

Subacute Papular Cutaneous Sarcoidosis Resistant to Conventional Therapy: A Case Report.

Sarcoidosis is a multisystem disease of obscure etiology that may involve almost any organ system; therefore, it results in various clinical manifestations. We are presenting a case of 60-year-old female complaining of multiple raised skin colored, to reddish lesions over face and few lesions over neck and extremities since 4 months cutaneous examination revealed multiple well defined skin colored to erythematous papulo-nodular lesions involving whole face with few discrete papular lesions over neck and extremities. Nasal skin was globular, studded with multiple nodules suggestive of lupus pernio. Histopathology showed many non-caseating naked epithelioid cell granulomas of variable sizes in the dermis. He was given oral methylprednisolone 16 mg twice daily after meal along with oral methotrexate 15 mg once in a week and tablet hydroxychloroquine 200 mg twice daily with keeping an eye over related adverse effects of all prescribed drugs. Still patient did not get remission after 6 months of a complete therapy. Due to the rarity of this disorder and its non-responding nature and course with conventional modalities of treatment made us to report this article for further studies and research.

Delayed diagnosis of sarcoidosis is common in Brazil / Diagnóstico tardio da sarcoidose é comum no Brasil

OBJECTIVE: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. METHODS: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed (≥ 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment). RESULTS: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis (≥ 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively). CONCLUSIONS: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis. .

OBJETIVO: Avaliar a frequência do diagnóstico tardio de sarcoidose no Brasil e os fatores relacionados a esse atraso. MÉTODOS: Avaliamos pacientes com diagnóstico de sarcoidose confirmado por biópsia utilizando um questionário que abordava o tempo entre o início dos sintomas e a data da primeira consulta médica; e o número e especialidades dos médicos consultados. Sintomas sistêmicos e pulmonares, envolvimento extratorácico, dados espirométricos, estadiamento radiológico, escolaridade, renda individual e diagnóstico/tratamento de tuberculose foram comparados entre os pacientes com diagnóstico precoce (< 6 meses até o diagnóstico) e tardio (≥ 6 meses). RESULTADOS: Foram incluídos 100 pacientes. A mediana do número de médicos consultados foi 3 (variação: 1-14). O diagnóstico de sarcoidose foi feito na primeira consulta em 11 casos. Um clínico geral foi inicialmente consultado em 54 casos. O diagnóstico de sarcoidose foi precoce em 41 casos e tardio em 59. Não houve diferença entre os grupos no tocante ao gênero, raça, tipo de seguro saúde, escolaridade, renda, sintomas sistêmicos e respiratórios, envolvimento extratorácico e estadiamento radiológico. Os pacientes com diagnóstico tardio apresentavam menor CVF (80,3 ± 20,4% vs. 90,5 ± 17,1%; p = 0,010) e VEF1 (77,3 ± 19,9% vs. 86,4 ± 19,5%; p = 0,024), além de mais frequentemente receberem diagnóstico de tuberculose (24% vs. 7%; p = 0,032) e tratamento para tuberculose (≥ 3 meses; 20% vs. 0%; p = 0,002). CONCLUSÕES: O diagnóstico de sarcoidose é tardio em muitos casos, mesmo quando há achados de imagem sugestivos. O diagnóstico tardio está associado a menor função pulmonar na época do diagnóstico. Vários ...

Tattoo reactions-An epidemic on the surge: A report of 3 cases.

Tattooing has been practiced in India since ancient era. It has tremendous religious and spiritual significance. In addition, tattooing for cosmetic purposes has become quite popular in recent times. With this increasing trend, there is also an increased risk of adverse effects. Here, we have described two cases of lichenoid reaction developing to red ink in double- colored tattoos and a case of sarcoidal reaction to green tattoo.

Características epidemiológicas de pacientes com sarcoidose na cidade do Rio de Janeiro / Epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil

OBJETIVO: Analisar as características epidemiológicas de pacientes com sarcoidose na cidade do Rio de Janeiro. MÉTODOS: Estudo descritivo, caso-controle, envolvendo 100 pacientes com sarcoidose acompanhados no Hospital Universitário Pedro Ernesto, localizado na cidade do Rio de Janeiro, entre 2008 e 2010. O diagnóstico de sarcoidose foi baseado em critérios clínicos, radiográficos, laboratoriais e histopatológicos. RESULTADOS: A doença predominou em mulheres (65 por cento), na faixa de 35-40 anos (variação: 7-69 anos), embora houvesse um segundo pico na população de aproximadamente 55 anos. A dispneia foi o sintoma mais comum (47 por cento), assim como o achado radiográfico de comprometimento pulmonar e linfonodal (estágio II; 43 por cento), seguido por estágio III (20 por cento), estágio 1(19 por cento), estágio 0 (15 por cento) e estágio IV (3 por cento). Nenhum paciente apresentou derrame pleural ou baqueteamento digital no diagnóstico. O PPD foi não reator em 94 pacientes. Os achados espirométricos no diagnóstico foram normais em 61 pacientes; indicativos de distúrbio ventilatório obstrutivo, em 21; e indicativos de distúrbio ventilatório restritivo, em 18. Os sítios de biópsia mais comuns foram os pulmões (principalmente por broncoscopia) e a pele, que confirmaram o diagnóstico em 56 por cento e 29 por cento dos casos, respectivamente. O tratamento com prednisona foi iniciado em 75 por cento dos pacientes e mantido por mais de 2 anos em 19,7 por cento. CONCLUSÕES: Este estudo corrobora vários achados relatados em outros estudos sobre as características epidemiológicas de pacientes com sarcoidose.

OBJECTIVE: To analyze the epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil. METHODS: A descriptive, case-control study involving 100 sarcoidosis patients under outpatient treatment between 2008 and 2010 at the Pedro Ernesto University Hospital, located in the city of Rio de Janeiro, Brazil. The diagnosis of sarcoidosis was based on clinical, radiological, biochemical, and histopathological criteria. RESULTS: There was a predominance of females in the 35-40 year age bracket (range, 7-69 years), who accounted for 65 percent of the sample, although there was a second peak at approximately 55 years of age. The most common symptom was dyspnea (in 47 percent), and the most common radiological findings were pulmonary and lymph node involvement (stage II; in 43 percent), followed by stage III (in 20 percent), stage I (in 19 percent), stage 0 (in 15 percent), and stage IV (in 3 percent). No pleural effusion or digital clubbing was observed at diagnosis. The tuberculin skin test was negative in 94 patients. Spirometric findings at diagnosis were normal in 61 patients; indicative of obstructive lung disease in 21; and indicative of restrictive lung disease in 18. The most common biopsy sites were the lungs (principally by bronchoscopy) and the skin, the diagnosis being confirmed by biopsy in 56 percent and 29 percent of the cases, respectively. Treatment with prednisone was initiated in 75 percent of the patients and maintained for more than 2 years in 19.7 percent. CONCLUSIONS: This study corroborates the findings of previous studies regarding the epidemiological characteristics of sarcoidosis patients.

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.

49-year-old woman with refractory chronic sinusitis. Sarcoidosis with granulomatous sinusitis Photo Quiz

A 49-year-old married, non- smoker housewife had purulent rhinorrhea, nasal congestion, post nasal drip [PND], and feeling of sinus pressure following an episode of common cold. She had no complaints of fever, cough, dyspnea, or arthralgia. Physical examination revealed PND and a posterior auricular lymphadenopathy [1cm X 1cm]. The patient received amoxicillin for 2 weeks with mild improvement. But again, she experienced the exacerbation of signs and symptoms a week later. CT-scan of the paranasal sinuses was performed [Figure 1]. She also had erythematous patches on her face around the right eye and her back, along with splenomegaly. The patient was treated with amoxicillin/clavulanate [for two weeks], loratadine, and beclomethasone nasal spray as well as normal saline nasal wash. There was a slight improvement in patient's signs but, repeatedly after two weeks signs and symptoms exacerbated. Due to the lack of response to antibiotics, a biopsy of the skin lesion was taken which revealed the following histopathological findings

Sarcoidosis: a delayed or missed diagnosis in children

Sarcoidosis is an idiopathic granulomatous disease, most commonly affecting young adults and presenting with bilateral hilar lymphadenopathy and pulmonary infiltrates [1]. In children it is relatively rare and its clinical spectrum varies according to the age of onset [1-2] It is more common during adolescence and usually presents with clinical features similar to the adult type. In children under the age of 4 years it is rare and has a different presentation. Clinical features are characterized by a triad of rash, uveitis, and arthritis.[3] Sarcoidosis has a worldwide distribution, but is more frequently reported from developed countries.[4,5. To our knowledge, there are no reports of childhood Sarcoidosis from Saudi Arabia. We describe the clinical and laboratory features, treatment and outcome of 8 children with sarcoidosis seen at our hospital

[Uncommun and serious complication of pulmonary sarcoidosis: neurosarcoidosis]

The incidence of neurosarcoidosis is about 5 to 15% of sarcoidosis in most clinical or post-mortem series. Central nervous system involvement is extremely uncommon and more serious than peripheral nerves. We discribe a case of sarcoidosis with central nervous system involvement in a 61 old woman how developped pulmonary sarcoidosis. After 4 months of treatment with corticosteroids, the patient presented with headaches, episods of altered consiousness, cerebellous syndrome and right hemiparesis. Analysis of cerebrospinal fluid was normal. CT scan and MRI examination of the head revealed mass like lesions in cerebellar region and periventricular white matter. A clinical diagnosis of neurosarcoidosis was made and treatment with Methylprednisone was recommended followed by immunosuppressive drug. 3 months after, symptoms had improved but the MRI showed the same mass lesions and the patient died after 12 months. Involvement of the central nervous system is an uncommon and serious complication of sarcoidosis, we should think about it in patients with neurological manifestations who developed a sarcoidosis