We report the case of a 74-year-old woman with elevated liver enzyme levels in whom abdominal sonographic examination revealed a diffusely heterogeneous liver parenchyma and multiple hypoechoic subcentimetric splenic nodules. Contrast-enhanced sonography (CEUS) revealed that the splenic focal lesions did not enhance. CT examination revealed a low-density, multinodular pattern both in the liver and in the spleen. Core biopsy of 1 hepatic nodule revealed noncaseating epithelioid cell granuloma, and the patient was diagnosed with systemic sarcoidosis. CEUS has shown to be useful in the diagnosis of focal hepatic lesions, but studies referring to splenic lesions are lacking.

Splenic focal lesions as manifestation of sarcoidosis: Characterization with contrast-enhanced sonography

Background
Sarcoidosis is a granulomatous disease of unknown aetiology. Over 90% patients of sarcoidosis present with pulmonary findings. Other organs such as lymph nodes, skin, and joints may be involved. Isolated granulomatous disease confined to the spleen is rare.

/pdf/surgical-cure-for-non-parathyroid-hypercalcemia-3ucd5oux3c.pdf

'Surgical cure' for non-parathyroid hypercalcemia

Resume Introduction Les principaux effets secondaires des biotherapies anti-TNF alpha sont maintenant bien connus, notamment le risque d’infections opportunistes. Certains effets paradoxaux sont plus exceptionnellement decrits, tels que le developpement de reactions granulomateuses de type sarcoidose. Observation Nous rapportons ici l’observation d’une femme de 39 ans suivie pour une polyarthrite rhumatoide severe traitee par etanercept depuis cinq ans, hospitalisee en urgence pour vomissements et douleurs abdominales diffuses revelant une hypercalcemie majeure avec insuffisance renale aigue. Apres correction des troubles metaboliques sous hydratation et biphosphonates, le scanner thoracoabdominopelvien a montre la presence d’un syndrome interstitiel bilateral et d’une volumineuse splenomegalie heterogene. Le diagnostic de sarcoidose a ete confirme par les biopsies bronchiques perendoscopiques. L’evolution a ete favorable apres l’arret de l’etanercept et une corticotherapie a doses decroissantes. Conclusion Le risque de sarcoidose induite doit etre connu chez les patients sous anti-TNF et doit etre evoque en cas d’hypercalcemie majeure et/ou de splenomegalie.

Severe hypercalcemia revealing sarcoidosis precipitated by etanercept

Sarcoidosis is a multi-organ granulomatosis  of unknown  origin. Modern  diagnostic methods  allow detecting  this disease at an early stage. The absence of specific markers requires a comprehensive  approach  to diagnosis based on comparison  of radiation,  clinical, morphological  and functional data. The course of sarcoidosis without damage to the respiratory system presents significant difficulties. It is extremely important  to understand the time and means of starting Sarcoidosis’s treatment to avoid the early initiation  of hormones  and cytostatics and, on the other hand,  to timely respond to progression and threatening  conditions.  Methods. Clinical recommendations are based on the analysis of Russian and English publications of the latest sarcoidosis research. The target audience of these clinical guidelines are therapists, general practitioners, pulmonologists, TB doctors, rheumatologists,  dermatologists,  radiation diagnosticians,  immunologists,  and clinical pharmacologists.  Each thesis-recommendation for diagnosis and treatment is evaluated on an 1 to 5 scale of levels of evidence and an A, B, C scale of the grades of recommendations. The clinical guidelines also contain comments and explanations for the theses-recommendations, diagnostic algorithms, treatment strategies, reference materials on the use of recommended drugs. Conclusion. Current information  on epidemiology, clinical manifestations,  diagnosis and management  strategies for patients with sarcoidosis are covered in the presented clinical guidelines. Approved by the decision of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (2022).

Sarcoidosis: federal clinical guidelines for diagnosis and treatment

Sarcoidosis is a multisystemic disease of unknown origin characterized by the formation of non-caseating granulomas. Thoracic involvement is the most common presentation; however, sarcoidosis can involve almost any other organ. To the best of our knowledge there have been only 10 cases of splenic sarcoidosis reported in the English literature, with no reports of sarcoidosis of an accessory spleen. The present study reports a case of isolated sarcoidosis of an accessory spleen in the greater omentum, which was identified postoperatively in a 44-year-old female. Chest X-ray results were normal. Gastric endoscopy demonstrated an ulcer in the antrum, which was confirmed to be a signet-ring cell carcinoma via biopsy. Computed tomography of the abdomen revealed mild thickening of the posterior antrum, and a mass in the inferior pole of the left kidney. Intraoperatively, no masses were detected in the liver and spleen. Moreover, no enlarged lymph nodes were detected in the abdominal cavity, pelvic cavity, mesenteric and para-aorta. Following a radical distal gastrectomy and left radical nephrectomy, postoperative pathology demonstrated signet-ring cell carcinoma in the antrum, left renal clear cell cancer and a red lesion measuring 0.5×0.5 cm in the greater omentum, which was similar to the spleen in the splenic cavity and was regarded as an accessory spleen. Following exclusion of fungi and acid-fast bacilli as causative agents, sarcoidosis of the accessory spleen in the greater omentum was confirmed. The patient recovered uneventfully and was discharged on day 8 postoperation. The patient remained alive after two-year follow-up without sarcoidosis and malignant tumor recurrence. The present case demonstrated that, intraoperatively, comprehensive exploration should be conducted to exclude the accessory spleen, which may also suffer from sarcoidosis.

https://www.spandidos-publications.com/10.3892/etm.2016.3221/download

Isolated sarcoidosis of accessory spleen in the greater omentum: A case report.

Resume Propos. – Description clinique, biologique et evolutive de patients presentant une splenomegalie dans le cadre d’une sarcoidose systemique. Methode. – Etude retrospective de 17 dossiers de patients presentant une splenomegalie et une sarcoidose prouvee histologiquement. Resultats. – La splenomegalie est de decouverte clinique chez 13 patients, superieure a 4 cm de debord costal chez 11 patients et douloureuse dans cinq cas. Les signes cliniques le plus souvent associes sont une alteration de l’etat general avec un syndrome febrile (n = 9) et une hepatomegalie (n = 7). La radiographie thoracique est normale dans cinq cas et montre des adenopathies mediastinales chez neuf patients. On note frequemment une elevation de l’enzyme de conversion de l’angiotensine (81 %), une thrombopenie (n = 5) ou une pancytopenie (n = 5). Une corticotherapie est prescrite chez 88 % des patients avec une efficacite constante sur les symptomes douloureux, la taille de la rate et les anomalies biologiques associees. La corticotherapie, pas plus que la splenectomie realisee chez deux patients pour exclure un lymphome ne semblent modifier l’evolution au long cours de la maladie. La sarcoidose est le plus souvent multiviscerale et d’evolution chronique dans 82 % des cas. Conclusion. – Une splenomegalie peut s’observer au cours de la sarcoidose et poser des problemes de diagnostic differentiel avec un lymphome. La prise en charge de ces patients est mal codifiee, la corticotherapie est reservee aux formes symptomatiques ou aux splenomegalies massives. La splenomegalie s’integre le plus souvent dans le cadre de sarcoidoses chroniques et multiviscerales.

Les splénomégalies sarcoïdosiques : caractéristiques cliniques et évolutives. À propos de 17 observations

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Les splénomégalies sarcoïdosiques : caractéristiques cliniques et évolutives. À propos de 17 observations