Tomography by emission of positrons in the diagnosis of sarcoidosis and Löfgren's syndrome
Keywords:
sarcoidosis, bilateral hilar lymphadenopathy, erythema nodosum, Löfgren's syndrome, PET-CTAbstract
Sarcoidosis is a multisystemic, non-caseating granulomatous disease of unknown cause that involves the lung and the mediastinal lymph nodes in between 90% and 95% of cases. It can also affect other organs, such as the salivary glands, skin, eyes, liver, spleen, heart, bones, and central nervous system. Thoracic involvement represents the main cause of morbidity and mortality in patients with this entity, which occurs in about 10 / 100,000 people a year. Our study aimed to present a 45-year-old patient treated for presenting clinical, paraclinical and radiological manifestations that allow the diagnosis of an acute form of sarcoidosis to be established without confirming by histological study. Its clinical form of expression showed the presence of Löfgren's syndrome with bilateral mediastinal widening due to hilar lymphadenopathy, febrile syndrome, erythema nodosum, and acute arthritis in the lower limbs, which 20-30% of patients with sarcoidosis develop. A positron emission tomography scan was performed and its results offered us diagnostic elements typical of a pulmonary inflammatory process far from the characteristics of a malignant neoplastic process.Downloads
References
Martínez Martínez y col. Sarcoidosis al descubierto: Lo que deberíamos informar en las imágenes torácicas. Rev Argent Radiol. 2019;83:77–86.
Ungprasert P1, Crowson CS, Matteson EL. -Epidemiology and clinical characteristics of sarcoidosis: an update from a population-based cohort study from Olmsted County, Minnesota. Reumatismo. 2017 May Clin Proc. 2016 Feb;91(2):183-8. doi: 10.1016/j.mayocp.2015.10.024.
Ungprasert P1, Carmona EM2, Utz JP2, Ryu JH2, Crowson CS3, Matteson EL4. Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Curr Rheumatol Rev. 2019 Oct 21. doi: 10.2174/1573397115666191021154628
Chavarriaga-Restrepo A, López-Amaya JE, Mesa-Navas MA, Velásquez Franco CJ. Sarcoidosis: muchas caras, una enfermedad. Revisión narrativa de la literatura. Latreia.2019 Jul-Sep;32(3):191-203.
Mussetti A, Vignoli l, Curbelo p, Meerovich E. Sarcoidosis Pulmonar. Neumología y cirugía de tórax, 2006; Vol. 65(S3):S36-S46.
Almaguer-Morales D1, Hinojosa-González DE2, Garza-Alpirez A1. Löfgren Syndrome with Hypercalcemia and Neuro-endocrinological Involvement: A Case Report. Treasure Island (FL): Stat Pearls Publishing; 2020-. 2019 Jul 20.
Brown F1, Tanner LS. Lofgren Syndrome. Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020-. 2019 Jul 20
C. Fernando Gatti, P. Prahl, P. Troielli, R. Schroh. Sarcoidosis. Un enfoque global. Med Cutan Iber Lat Am 2008;36(4):165-182)
Sánchez García-Altares MJ, et al. Sarcoidosis. Med Gen y Fam. 2016.http://dx.doi.org/10.1016/j.mgyf. 2015.11.009
Tohoku J, Ishimatsu Y1, Koyama H, Tomonaga M, Harada T, Nakashima S, Hara A, Hara S, Kakugawa T, Sakamoto N, Hayashi T, Kohno S. Japanese patient with Löfgren's syndrome with an HLA-DR12 allele and review of literature on Japanese patients. Tohoku J Exp Med. 2014 Oct;234(2):137-41.A
Rubio-Rivas M1, Franco J2, Corbella X3. Sarcoidosis presenting with and without Löfgren's syndrome: Clinical, radiological and behavioral differences observed in a group of 691patients. Joint Bone Spine. 2019 Oct 11. pii: S1297-319X(19)30147-2. doi: 10.1016/j.jbspin.2019.10.001.
Barahona Z.D. ¿Cuándo solicitar PET/CT en la evaluación de sarcoidosis?.Rev Med Chile 2019; 147: 1308-1314
Torquato MF1, Costa MKSD2, Nico MMS2. Dermatologic aspects and cutaneous manifestations of sarcoidosis. G Ital Dermatol Venereol. 2010 Dec;145(6):733-45.
Blake T1, Manahan M, Rodins K. Erythema nodosum - a review of an uncommon panniculitis. Dermatol Online J. 2014 Apr 16;20(4):22376.
Mañá J1, Rubio-Rivas M, Villalba N, Marcoval J, Iriarte A, Molina-Molina M, Llatjos R, García O, Martínez-Yélamos S, Vicens-Zygmunt V, Gámez C, Pujol R, Corbella X Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis: Cohort study of a 40-year clinical experience at a tertiary referral center in Barcelona, Spain 1Medicine (Baltimore). 2017 Jul;96(29):e7595. doi: 10.1097/MD.0000000000007595.
Torquato MF1, Costa MKS2, Nico MMS2Cutaneous sarcoidosis: clinico-epidemiological profile of 72 patients at a tertiary hospital in São Paulo, Brazil. An Bras Dermatol. 2019 Nov 30. pii: S0365-0596(19)30152-7. doi: 10.1016/j.abd.2019.06.004.
Piérard GE1, Piérard-Franchimont C2.Erythema nodosum : a panniculitis of diverse origins. Rev Med Liege. 2017 Jan;72(1):43-44
Inui N, Murayama A, Sasaki S, Suda T, Chida K, Kato S, et al. Correlation between 25-hydroxyvitamin D3 1 alpha-hydroxylase gene expression in alveolar macrophages and the activity of sarcoidosis. Am J Med. 2001 Jun 15. 110(9):687-93. [Medline].
Zhao M1, Xin XF1, Hu H1, Pan XH1, Lv TF1, Liu HB1, Zhang JY1, Song Y1 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis of benign pulmonary lesions in sarcoidosis. Transl Lung Cancer Res. 2019 Jun;8(3):208-213. doi: 10.21037/tlcr.2019.06.09.
Treglia G1, Annunziata S2, Sobic-Saranovic D3, Bertagna F4, Caldarella C2, Giovanella L5. The role of 18F-FDG-PET and PET/CT in patients with sarcoidosis: an updated evidence-based review. Acad Radiol. 2014 May;21(5):675-84. doi: 10.1016/j. acra. 2014. 01.008.
Ordóñez-Rubiano EG1, Solano-Noguera DF2, Row W3, Weinberg J4, Tatsui CE4, Johnson JM3, Gule-Monroe MK3. Dual Time-Point 18F-FDG PET/CT in Spinal Sarcoidosis: A Single Institution Case Series. Spine (Phila Pa 1976). 2019 Nov 1;44(21):E1248-E1255. doi: 10.1097/BRS.0000000000003122.
Larici AR1, Glaudemans AW2, Del Ciello A1, Slart RH2,3, Calandriello L4, Gheysens O5. Radiological and nuclear medicine imaging of sarcoidosis Q J Nucl Med Mol Imaging. 2018 Mar;62(1):14-33. doi: 10.23736/S1824-4785.17.03046-1. Epub 2017 Nov
Chen H1, Jin R2, Wang Y1, Li L1, Li K1, He Y1. The Utility of 18F-FDG PET/CT for Monitoring Response and Predicting Prognosis after Glucocorticoids Therapy for Sarcoidosis. -Biomed Res Int. 2018 Mar 1;2018:1823710. doi: 10.1155/2018/1823710. eCollection 2018.
Akaike G1, Itani M1, Shah H1, Ahuja J1, Yilmaz Gunes B1, Assaker R1, Behnia F1. PET/CT in the Diagnosis and Workup of Sarcoidosis: Focus on Atypical Manifestations. Radiographics. 2018 Sep-Oct;38(5):1536-1549. doi: 10.1148/rg.2018180053. Epub 2018 Aug 17
Hamdi W1, Néji O, Ghannouchi MM, Kaffel D, Kchir MM. Rheumatologic manifestations of sarcoidosis]. Tunis Med. 2010 Nov;88(11):773-82 [Article in French]
Morasert T1, Jongjaroonrangsun M2, Smithtithiti S3, Bhummichitra K Sarcoidosis with multiorgan involvement.Postgrad Med J. 2019 Dec 19. pii: postgradmedj-2019-137219. doi: 10.1136/postgradmedj-2019-137219.
Promteangtrong C1, Salavati A, Cheng G, Torigian DA, Alavi A.The role of positron emission tomography-computed tomography/magnetic resonance imaging in the management of sarcoidosis patients.Hell J Nucl Med. 2014 May-Aug;17(2):123-35.
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