Recurrent sarcoidosis on a scar associated with vitiligo.

We report a case of systemic sarcoidosis, diagnosed 13 years ago by transbronchial biopsy. Our patient had a spontaneous resolution of hilar and mediastinal lymphadenopathy 6 months after diagnosis. She presented with a skin rash on her thyroidectomy scar after a period of 4 years of complete remission. The patient complained that her thyroidectomy incision scar rose up, reddened and hardened. Biopsy of the skin lesion revealed non-caseating epithelioid granulomas with histiocytes and multinucleated giant cells. She was successfully treated with oral prednisone. Scar sarcoidosis recurred twice in a 7-year follow-up period without accompanying systemic sarcoidosis. Vitiligo appeared with the last relapse of scar sarcoidosis. The case we present is of interest due to the recurrent attacks of scar sarcoidosis in a patient during the remission period of systemic sarcoidosis. Another aspect of this case is the association of the disease with vitiligo without any sign of an autoimmune disease.

Effects of inhaled budesonide on insulin sensitivity in nondiabetic patients with asthma and chronic obstructive pulmonary disease.

In the study reported here, investigators explored the following: (1) the effects of inhaled corticosteroid (ICS) therapy on insulin sensitivity (IS) (the Homeostatic Model Assessment-Insulin Resistance [HOMA-IR] Index, which has never been used before in nondiabetic patients with asthma and chronic obstructive pulmonary disease [COPD], was used in this investigation); and (2) differences and similarities between asthma and COPD groups. A total of 12 patients with asthma and 6 with COPD who were not previously treated with oral corticosteroids or ICSs were treated with budesonide, 400 microg twice daily for 8 wk, via dry powder inhaler through the Aerolizer. Pretreatment and posttreatment values were recorded for forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), FEV(1)/FVC, C-reactive protein (CRP), blood glucose, serum insulin levels, area under the curve (AUC) for glucose and insulin in an oral glucose tolerance test (OGTT), and HOMA-IR Index. The trapezoid technique, the formula for HOMA-IR, and Wilkinson, Mann-Whitney U, and t tests were used. In the group of patients with asthma, posttreatment values for the HOMA-IR Index, glucose, and insulin at all time points during OGTT and AUC for glucose and AUC for insulin were not statistically different compared with pretreatment values. In patients with COPD who had been given ICS therapy, however, the second hour glucose level during OGTT increased significantly compared with pretreatment values (P=.46). Pretreatment and posttreatment second hour insulin values and posttreatment AUC for glucose were significantly higher in the COPD group than in the asthma group (P=.047, P=.044, and P=.031, respectively). A moderate positive correlation was noted between the percentage of difference in FEV1 and the change in HOMA-IR (pretreatment mean value of HOMA-IR+/-standard deviation [SD], 2.7+/-2.6) in asthmatic patients as the result of therapy (r=0.50, P=.138). Investigators concluded the following: (1) Differences in pathogenesis between asthma and COPD seem to offer the most plausible explanation for differences in carbohydrate metabolism achieved through ICS therapy; (2) the effect of an ICS on IS is associated not only with dose, treatment period, age, and body mass index (BMI) but also with the severity of initial mucosal inflammation; and (3) as a result of improvements in respiratory function noted after treatment had been given, IS was increased in asthmatic patients.

Seasonality of the onset of symptoms, tuberculin test anergy and Kveim positive reaction in a large cohort of patients with sarcoidosis.

BACKGROUND AND OBJECTIVES: Sarcoidosis is a systemic granulomatous disease of unknown aetiology and pathogenesis. This study evaluated the seasonal variation in the onset of symptoms, Tuberculin anergy and Kveim positive reaction in a cohort of 492 patients with sarcoidosis and in a subgroup of 248 patients with known Kveim test responses. METHODS: The medical records of 492 patients with sarcoidosis were retrospectively reviewed. Roger's test for cyclic variation was used to assess the statistical significance of the observed seasonal variation. RESULTS: For all sarcoidosis patients (n = 492) the onset of symptoms was most frequent in spring (61.8%) and least frequent in summer (31.7%) (P < 0.001). For patients with Tuberculin anergy (n = 364) the onset of symptoms was most frequent in spring and least frequent in autumn (P < 0.001); there was no seasonal variation among Tuberculin positive patients (n = 128). Of those patients with a Kveim test result (n = 248), the onset of symptoms was most frequent in spring and least frequent in summer (P < 0.001); there was no seasonal variation for patients with a negative Kveim results (n = 50 patients). CONCLUSIONS: The onset of the symptoms was most frequent in spring and least frequent in the second half of the year (summer or autumn) in patients with sarcoidosis, Tuberculin anergy and a positive Kveim reaction. The significance of this finding in relation to aetiology and clinical utility needs to be further assessed.

Analysis of 275 patients with sarcoidosis over a 38 year period; a single-institution experience.

BACKGROUND: Sarcoidosis is a systemic granulomatous disease with unknown etiology. OBJECTIVES: We evaluated seasonal variation, demographic, clinical and diagnostic features of sarcoidosis in recently diagnosed symptomatic patients in the whole cohort (275 patients) and in the subgroups according to the estimated disease course (subacute course group vs. chronic course group). We also developed a prediction model to predict the course of sarcoidosis using simple clinical and demographic variables. MATERIAL AND METHODS: Two hundred and seventy-five patients with sarcoidosis. MEASUREMENTS AND STATISTICS: Roger's test, chi-square, t-test and multiple logistic regression were used. RESULTS: The distribution of cumulative monthly diagnosis was the lowest in November (fall) (p<0.01). Seasonal pattern was influenced by age and gender. Constitutional symptoms, stages 2 and 3 diseases and the absence of erythema nodosum were highly significant parameters for chronic course. Using these variables, the developed model had a specificity of 93.1% and its positive predictive value was 89.5%. Progression of the disease was documented 6.4% in subacute group vs. 32.1% in chronic group (p=0.00001). Preventive effect of smoking was more pronounced in females than in males in our cohort. CONCLUSIONS: Further well-designed and large prospective studies are required to better understand the importance of these findings, and to validate the prediction model presented here.