Cases reported "Sarcoidosis"

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1/4. Renal failure and hypercalcemia as initial manifestations of extrapulmonary sarcoidosis.

    sarcoidosis is a granulomatous, multisystem disease. Rarely, sarcoidosis may present with both renal failure and hypercalcemia. A 27-year-old black man presented with severe abdominal pain and renal failure. A kidney biopsy demonstrated features of both interstitial nephritis and membranous glomerulopathy thought to be secondary to nonsteroidal anti-inflammatory drugs. His renal function and symptoms improved with short-term prednisone therapy. Discontinuation of steroids led to a recurrence of renal failure and severe hypercalcemia. On the basis of an elevated angiotensin-converting enzyme level of 160 U/L and anemia, a bone marrow biopsy was performed. Acid-fast bacillus-negative, noncaseating granulomas suggested the diagnosis of sarcoidosis. The patient recovered after restarting prednisone. sarcoidosis may cause both interstitial and membranous nephritis from direct infiltration. hypercalcemia results from increased calcium absorption secondary to 1,25-dihydroxyvitamin D production by sarcoid granulomas. sarcoidosis must be considered in the differential diagnosis of renal failure in black patients. Serum calcium and angiotensin-converting enzyme levels may aid the diagnosis.
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ranking = 1
keywords = bacillus
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2/4. Rapidly advancing periodontitis in a patient with sarcoidosis. A case report.

    A brief review of sarcoidosis is presented. It is a multisystem granulomatous disease of unknown etiology. Typically the sarcoidosis patient manifests depressed T-cell function but has hyperactive B-cells. This case report deals with a 27-year old black female who was diagnosed as having sarcoidosis. Prior to the onset of the disease, radiographs taken of her periodontium revealed incipient alveolar bone loss. Two years after the apparent onset of the sarcoidosis, periapical radiographs manifested advanced destruction of the alveolar bone. In addition to the usual clinical indices, the effect of the patient's serum on cultures of normal PMNs and actinobacillus actinomycetemcomitans (A. a.) was studied. The serum from this patient inhibited the leukotoxic effect of the (A. a.) organism. A similar effect has been observed in juvenile patients with rapidly advancing periodontitis.
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keywords = bacillus
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3/4. Intrathecal production of oligoclonal IgM and IgG in CNS sarcoidosis.

    A longitudinal study of multiple paired CSF and serum specimens from a patient with CNS sarcoidosis revealed high CSF IgM and IgG indices as well as oligoclonal IgM and IgG bands in CSF reflecting intrathecal IgM and IgG production. The antibody specificity of intrathecally-produced IgM and IgG remained undefined despite analysis for antibodies against mycobacterium tuberculosis and Kveim suspension. Steroid treatment induced rapid and complete clinical remission, and also decrease of CSF IgM and IgG antibodies, while oligoclonal IgM and IgG persisted in CSF. Repeated determinations of these CSF variables together with cell count and CSF/serum albumin ratio as a variable of blood-brain barrier function, might be useful in assessing effect of therapy in CNS sarcoidosis.
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ranking = 1.8582988632286
keywords = mycobacterium
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4/4. Cerebral relapse of sarcoidlike Whipple's disease.

    Whipple's disease, an infection with the recently identified intracellular bacillus tropheryma whippelii, is a systemic disorder that can be life threatening when untreated. In a few patients, the signs and symptoms of the disease are similar to those of sarcoidosis, and this illness is referred to as sarcoidlike Whipple's disease. This variant must be recognized because patients with sarcoidlike Whipple's disease must be treated with antibiotics instead of corticosteroids, which would be indicated for patients with true sarcoidosis. We describe a 53-year-old man who had sarcoidlike Whipple's diseases with polyvisceral granulomatous dissemination that was treated with procaine penicillin g and streptomycin followed by doxycycline. His condition initially improved. However, during his 4-month course of treatment he developed a cerebral relapse; this relapse was successfully treated with ceftriaxone and cefixime.
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ranking = 1
keywords = bacillus
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