Bone Marrow Involvement in Relapsed Sarcoidosis: A Case Report
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Sarcoidosis can involve multiple organs and is characterized by non-caseating granuloma on biopsy, which is not pathognomonic of this disease. Therefore, diagnosis requires exclusion of other causes of granuloma, including malignant neoplasm, infections, autoimmune diseases, drug exposure, environmental causes, lymphoma, and tuberculosis. Herein, we present a rare case of a patient with a primary manifestation of sarcoidosis, with typical bilateral hilar adenopathy, and recurrence in the bone marrow. A 50-year-old female patient, who had been diagnosed with sarcoidosis at age 38, was admitted for petechia on both legs and pancytopenia. The patient was concluded to be “highly probable” for sarcoidosis, with at least 90% likelihood, according to the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG) organ assessment instrument. Moreover, the patient had a bone marrow biopsy positive for granulomatous inflammation. Hence, all findings supported the diagnosis of sarcoidosis. Because sarcoidosis is difficult to definitively diagnose, it will be useful to better understand the application, interpretation, and limitations of the WASOG instrument for bone marrow involvement assessment.
Abstract
Sarcoidosis can involve multiple organs and is characterized by non-caseating granuloma on biopsy, which is not pathognomonic of this disease. Therefore, diagnosis requires exclusion of other causes of granuloma, including malignant neoplasm, infections, autoimmune diseases, drug exposure, environmental causes, lymphoma, and tuberculosis. Herein, we present a rare case of a patient with a primary manifestation of sarcoidosis, with typical bilateral hilar adenopathy, and recurrence in the bone marrow. A 50-year-old female patient, who had been diagnosed with sarcoidosis at age 38, was admitted for petechia on both legs and pancytopenia. The patient was concluded to be “highly probable” for sarcoidosis, with at least 90% likelihood, according to the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG) organ assessment instrument. Moreover, the patient had a bone marrow biopsy positive for granulomatous inflammation. Hence, all findings supported the diagnosis of sarcoidosis. Because sarcoidosis is difficult to definitively diagnose, it will be useful to better understand the application, interpretation, and limitations of the WASOG instrument for bone marrow involvement assessment.
참고문헌 (14)
- Akinsanya L, "Leucopenia as presentation of sarcoidosis", Int J Health Sci(Qassim), 2, pp.109~112 (2008)
- Al-Kofahi K, "Management of extrapulmonary sarcoidosis : challenges and solutions", Ther Clin Risk Manag, 12, pp.1623~1634 (2016)
- Zhou Y, "Clinical characteristics of patients with bone sarcoidosis", Semin Arthritis Rheum, 47, pp.143~148 (2017)
- Bickett AN, "Sarcoidosis diagnostic score : a systematic evaluation to enhance the diagnosis of sarcoidosis", Chest, 154, pp.1052~1060 (2018)
- Judson MA, "The diagnosis of sarcoidosis", Clin Chest Med, 29, pp.415~427 (2008)
- Park JE, "Prevalence, incidence, and mortality of sarcoidosis in Korea, 2003-2015: A nationwide population-based study", Respir Med, 144S, pp.S28~S34 (2018)
- Peña-Garcia JI, "bone marrow involvement in sarcoidosis : an elusive extrapulmonary manifestation", J Community Hosp Intern Med Perspect, 9, pp.150~154 (2019)
- Judson MA, "The three tiers of screening for sarcoidosis organ involvement", Respir Med, 113, pp.42~49 (2016)
- Judson MA, "The WASOG sarcoidosis organ assessment instrument : an update of a previous clinical tool", Sarcoidosis Vasc Diffuse Lung Dis, 31, pp.19~27 (2014)
- Ungprasert P, "Clinical manifestations, diagnosis, and treatment of sarcoidosis", Mayo Clin Proc Innov Qual Outcomes, 3, pp.358~375 (2019)
- Yachoui R, "Bone and bone marrow involvement in sarcoidosis", Rheumatol Int, 35, pp.1917~1924 (2015)
- Yanardağ H, "bone marrow involvement in sarcoidosis : an analysis of 50 bone marrow samples", Haematologia(Budap), 32, pp.419~425 (2002)
- "Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999", Am J Respir Crit Care Med, 160, pp.736~755 (1999)
- Eid A, "Differential diagnoses of bone marrow granuloma", West J Med, 164, pp.510~515 (1996)