Navegando por Palavras-chave "Sarcoidosis"
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- ItemAcesso aberto (Open Access)Delayed diagnosis of sarcoidosis is common in Brazil(Sociedade Brasileira de Pneumologia e Tisiologia, 2013-09-01) Rodrigues, Mauri Monteiro; Coletta, Ester Nei Aparecida Martins [UNIFESP]; Ferreira, Rimarcs Gomes [UNIFESP]; Pereira, Carlos Alberto de Castro [UNIFESP]; São Paulo Hospital for State Civil Servants Department of Respiratory Diseases; Universidade Federal de São Paulo (UNIFESP)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.
- ItemAcesso aberto (Open Access)Doenças granulomatosas ocupacionais(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-05-01) Bagatin, Ericson; Pereira, Carlos Alberto De Costa [UNIFESP]; Afiune, Jorge Barros; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP); Instituto Clemente FerreiraA variety of diseases are encompassed in the didactic denomination of granulomatous diseases of probable occupational etiology. As well as presenting similar clinical aspects, such diseases are characterized by certain common traits: formation of granulomas; systemic and respiratory manifestations; environmental or occupational exposure to organic or inorganic agents; and T lymphocyte involvement in the pathogenesis. Included in this category are hypersensitivity pneumonitis, mycobacteriosis (all forms) and sarcoidosis, as well as beryllium disease and other lung diseases caused by exposure to heavy metals. In order to highlight the risk of developing one of these diseases as a result of environmental or occupational exposure to etiologic agents, we address aspects related to epidemiology, pathogenesis and evaluation of exposure of these diseases, as well as those related to diagnostic criteria, prevention and control. We have given special emphasis to groups of individuals considered to be at high risk for developing these diseases, as well as to the need for health care professionals to remain aware of the potential occupational etiology of such diseases, a decisive factor in devising effective measures of prevention and epidemiological surveillance.
- ItemSomente MetadadadosEscore Multidimensional Simples Para Predição Do Curso Clínico Da Sarcoidose Na Avaliação Inicial(Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Castro, Marina Dornfeld Cunha [UNIFESP]; Pereira, Carlos Alberto De Castro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Sarcoidosis is a systemic granulomatous disease of unknown etiology. The outcome is variable and is mainly related to persistent inflammation process and development of fibrosis. Prognostic features have been described, but there is no validated model to predict the evolution of the disease. Aim: To find predictive features associated to clinical course of sarcoidosis at initial evaluation and develop a predictive score. Methods: This was a retrospective study of a cohort of patients with diagnosis of sarcoidosis, followed in reference centers involved in interstitial lung disease. Clinical, radiographic and functional data were compared by univariate analysis between patients with limited course – spontaneous involution or stability after a course of therapy and persistent – relapse or resistance to treatment, persistent treatment or chronic stable disease. Data related to persistent disease were selected by multivariate analysis and a prognostic score was developed.Results: 200 patients were included. 63% were female. Mean age at diagnosis was 50 years old. Median of time of symptoms was 12 months. Early diagnosis was characterized by time of symptoms ≤ 12 months and was found in 57% of cases. Dyspnea and cough were the most common pulmonary symptoms. Treatment for tuberculosis was prescribed before diagnosis in 44 patients. The most common radiologic stage was II (lung parenchyma and thoracic adenopathy). Mean forced vital capacity (FVC) was 84.9 ± 18.8% of predicted, with 37% of the cases with FVC below lower limit of reference. Relevant systemic involvement was detected in 37% of the patients. During the evolution, 77% of the cases needed immunosuppressive treatment and the course of disease was classified as persistent in 115 cases. By logistic regression, excluding 40 patients with pulmonary fibrosis, the findings related to persistent disease were: parenchymal lung involvement [odds ratio (OR) 3.83], late diagnosis (OR 2.82), dyspnea (OR 2.80), systemic involvement (OR 2.55) and reduced FVC (OR 2.33). A score was developed, taking into account the weight of the variable (1 point each), with positive predictive value for persistent disease in A score (≤ 1 point) and C score (≥ 4 points) of 17% and 88% respectively. Conclusion: A predictive score for sarcoidosis outcome can be derived by multiple variables at initial evaluation, allowing prediction of the clinical course of disease in a significant number of cases. The results should be confirmed in a validation cohort.
- ItemAcesso aberto (Open Access)Ocular sarcoidosis masked by positive IgM for toxoplasmosis(Consel Brasil Oftalmologia, 2017) Peres, Murilo Bertazzo [UNIFESP]; de Sousa, Jacqueline Martins [UNIFESP]; Nascimento, Heloisa [UNIFESP]IgG serology for toxoplasmosis. The patient was a young female with red painful eyes, bilateral eyelid edema, and panuveitis with periphlebitis. In laboratory testing, she was IgM and IgG positive for toxoplasmosis and anergic in the tuberculin test. Topical treatment for anterior uveitis and oral antibiotics for toxoplasmosis were started, without improvement. Orbit tomography showed increased lacrimal glands bilaterally, and chest X-ray radiographic findings were consistent with pulmonary sarcoidosis, which supported the presumed ocular sarcoidosis diagnosis. The patient was treated with oral prednisone and methotrexate without antibiotics. She showed clinical and vision improvement without recurrences during the 1-year follow-up. Ocular sarcoidosis is an important differential diagnosis requiring careful anamnesis and ophthalmological examinations. Ancillary tests, such as X-ray radiography, tomography, and clinical and laboratory evaluations may help rule out other causes. Treatment mainly consists of corticosteroids and immunosuppression.
- ItemSomente MetadadadosSarcoidose cutânea sobre cicatrizes - relato de caso(Soc Brasileira Dermatologia, 2010-11-01) Mantese, Sonia Antunes de Oliveira [UNIFESP]; Berbert, Alceu Luiz Camargo Villela; Cesario, Thais Silveira; Silva, Henrique Borges da; Universidade Federal de Uberlândia (UFU); Universidade Federal de São Paulo (UNIFESP)Sarcoidosis is a systemic inflammatory disorder of unknown origin, in which non-caseating granulomas (small inflammatory nodules) are found in the affected organs. Cutaneous involvement occurs in 25% of cases with a wide range of clinical presentation. The onset of scars is unsual although clinically characteristic of cutaneous sarcoidosis. Most patients with scar sarcoidosis have a systemic disease. It is reported the case of a 65 year-old woman that developed scar nodules 20 years after she had had surgical procedures without systemic manifestations. It is worth mentioning the importance of investigating sarcoidosis with inflammatory alterations in praevia scars.