trimethoprim--sulfamethoxazole-drug-combination and Sarcoidosis

Topics: Adult; Bartonella henselae; Biopsy, Needle; Cat-Scratch Disease; Humans; Immunohistochemistry; Male; Prednisone; Prognosis; Risk Assessment; Sarcoidosis; Sweet Syndrome; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

This study reports two cases of chronic paracoccidioidomycosis with sarcoid-like cutaneous lesions. The patients began the treatment in 2013 at Hospital Universitário Clementino Fraga Filho (HUCFF) of the Universidade Federal do Rio de Janeiro (UFRJ). The first case (mild form) was treated with trimethoprim-sulfamethoxazole (8 mg /kg per day, orally) for three months and, then, with half the dose for nine months; the second (moderate form), with itraconazole (200 mg per day, orally) for 12 months. We point out the rareness of the sarcoid-like cutaneous lesions and the differential diagnoses for other granulomatous diseases.

Topics: Antifungal Agents; Chronic Disease; Humans; Itraconazole; Male; Middle Aged; Paracoccidioidomycosis; Sarcoidosis; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Asthma; Biopsy; Diagnosis, Differential; Erythema Nodosum; Exanthema; Female; Humans; Irritable Bowel Syndrome; Leg; Lymphatic Diseases; Mycobacterium tuberculosis; Pain; Radiography; Sarcoidosis; Skin; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculin Test; Tuberculosis, Pulmonary

Two patients, a woman aged 66 and a man aged 56 years, with an inflammatory syndrome, weight loss, joint pain and abdominal lymphadenopathy received long-term treatment with corticosteroids for alleged sarcoidosis. No long-term remission was induced and the patients were referred for a second opinion. Eventually the diagnosis of Whipple's disease was established 5 years after the appearance of the first symptoms in the case of the female patient and 4 years after in the case of the male patient. Both patients showed a marked clinical improvement after treatment with trimethoprim-sulfamethoxazole. An atypical presentation of alleged sarcoidosis should suggest the possibility of Whipple's disease, especially in the case of gastrointestinal symptoms and the failure to respond to corticosteroids, and warrants duodenal biopsy. The presence of granulomas with an elevated angiotensin-converting enzyme level is not pathognomonic for sarcoidosis. It is vitally important to distinguish the two disorders, as Whipple's disease is an infectious disorder that requires antibiotic therapy to prevent a fatal outcome.

Topics: Abdomen; Adrenal Cortex Hormones; Aged; Anti-Infective Agents; Arthralgia; Diagnosis, Differential; Female; Humans; Lymphatic Diseases; Male; Middle Aged; Sarcoidosis; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

Sarcoidosis-lymphoma syndrome is a well-established syndrome where sarcoidosis is followed by the development of a lymphoproliferative disease such as non-Hodgkin's lymphoma (NHL). Here we report two patients with NHL who developed sarcoidosis subsequent to the diagnosis of lymphoproliferative disease. In both cases, chemotherapeutic treatment had already been initiated or was completed when sarcoidosis occurred. In these patients, sarcoidosis may have been triggered by immunologic aberrations induced by antineoplastic therapy or as a consequence of an underlying immunologic disturbance associated with the lymphoma. When a suspected relapse of lymphoma presents with signs and symptoms compatible with sarcoidosis, this rare immunologic disorder has to be ruled out by careful clinical and histopathologic analysis to prevent mistreatment.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Clarithromycin; Cyclophosphamide; Doxorubicin; Etoposide; Humans; Lung Diseases; Lymphoma, Follicular; Lymphoma, Large B-Cell, Diffuse; Male; Prednisolone; Prednisone; Rituximab; Sarcoidosis; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

Topics: Aged; Diagnosis, Differential; Humans; Male; Sarcoidosis; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Seven cases of single lung transplantation are reported. The recipients were all below 60 years of age and severely disabled with end-stage lung disease. Transplantation was performed according to ABO blood group compatibility and negative lymphocytotoxic cross-match between donor and recipient irrespective of HLA mismatch. Recipients' diagnoses were sarcoidosis (3), alfa-1 antitrypsin deficiency (3), and idiopathic emphysema (1). Mean recipient age was 48 +/- 2.4 years (range 45-52). Donor age was 29.7 +/- 5.6 years (range 16-49). The immunosuppressive regimen included cyclosporin A, azathioprine, steroids and rabbit antithymocyte globulin. Excellent graft function was achieved. Six patients survived the postoperative period and are alive 4-18 months posttransplant. One patient died after the operation due to pneumonia with respiratory distress syndrome. Graft function was also monitored by transbronchial biopsy, and 57 biopsy procedures were performed without fatal complications. Acute cellular rejection was seen in 16 biopsy specimens from 5 recipients (grade 1 and 2 rejection in 14, grade 3 rejection in 2). Neither severe rejection with septal necrosis (grade 4) nor obliterative bronchiolitis was seen. The rejection rate was 0.03 episodes per patient/month. In contrast to other reports, episodes of cellular rejection occurred throughout the observation period, and were not mainly limited to the first 4 months posttransplant. Graft vascular occlusive disease or chronic vascular rejection was found in 6 biopsy specimens from one recipient. Five patients experienced 7 episodes of cytomegalovirus infection. The cytomegalovirus infection rate was 0.01 episodes per patient/month. The incidence of infection was significantly lower compared to previous studies of rejection in other lung graft combinations. Both infections and rejection episodes may contribute to the development of obliterative bronchiolitis. Almost one third of the specimens (30%) showed lymphocytic bronchitis without perivascular inflammation. The absence of perivascular infiltrates and exclusion of infectious agents leaves in question the aetiology of this inflammation. The lymphocytic bronchitis could be ischaemic, related to aspiration, or represent recurrent sarcoidosis, or, in fact, express bronchial rejection. All biopsy specimens regarded as rejection with cellular infiltrates in the lung parenchyma also showed a lymphocytic bronchitis. The impact of HLA mismatch on cellular and vascu

Topics: Adult; alpha 1-Antitrypsin Deficiency; Biopsy, Needle; Bronchiolitis; Cytomegalovirus Infections; Emphysema; Female; Ganciclovir; Graft Rejection; Humans; Immunosuppression Therapy; Lung; Lung Diseases, Fungal; Lung Transplantation; Male; Middle Aged; Pneumonia, Pneumocystis; Respiratory Insufficiency; Sarcoidosis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Combined Modality Therapy; Female; Humans; Nose Diseases; Sarcoidosis; Trimethoprim, Sulfamethoxazole Drug Combination