Sarkoidozun Trombositopeni, Kemik İliği Tutulumu ve Miyokard İnfiltrasyonuyla Birlikte Olağandışı Klinik Görünümü: Olgu Sunumu
Öz
Bu vaka çalışmasında nefes darlığı ve çabuk yorulma şikayetleriyle başvuran 67 yaşında bir kadın hasta anlatılmaktadır. İlk semptomlar 2018 yılında, endobronşiyal ultrason (EBUS) kullanılarak sarkoidozu doğrulayan tanısal bir toraks BT taramasına yol açtı. Teşhise rağmen hasta tedavi görmemiştir. 2023 yılında yapılan kemik iliği biyopsisi, hastalığın kalp yetmezliği ve trombositopeniyi içerecek şekilde ilerlediğini ortaya koymuştur. Kardiyolojik inceleme için transtorasik ekokardiyografi (TTE) kullanıldı ve sol ventrikül duvar hareket bozukluğu tespit edildi. Manyetik rezonans görüntüleme (MRG), sol ventrikülde tam kat geç gadolinyum tutulumu (LGE) tespit ederek ciddi kardiyak etkilenmeyi ortaya koydu. Bu olgu sunumu sarkoidoz semptomlarının karmaşıklığını ve çeşitliliğini vurgulamakta, doğru tanı ve bireysel tedavi yaklaşımı için multidisipliner bir yaklaşımı desteklemektedir.
Anahtar Kelimeler
Sarkoidoz Trombositopeni Miyokardiyal İnfiltrasyon Kemik İliği Tutulumu
Kaynakça
- Arkema EV, Grunewald J, Kullberg S, Eklund A, Askling J. Sarcoidosis incidence and prevalence: A nationwide register-based assessment in Sweden. European Respiratory Journal. 2016; 48(6):1690–1699. Available from: https://doi.org /10.1183/13993003.00477-2016
- Rossides M, Darlington P, Kullberg S, Arkema EV. Sarcoidosis: Epidemiology and clinical insights. Journal of Internal Medicine. 2023; 293(6):668–680. Available from: https:// doi.org/10.1111/joim.13629.
- Damsky W, Wang A, Kim DJ, Young BD, Singh K, Murphy MJ, Daccache J, Clark A, Ayasun R, Ryu C, McGeary MK, Odell ID, Fazzone-Chettiar R, Pucar D, Homer R, Gulati M, Miller EJ, Bosenberg M, Flavell RA, King B. Inhibition of type 1 immunity with tofacitinib is associated with marked improvement in longstanding sarcoidosis. Nature Communications. 2022; 13(1):1–17. Available from: https://doi.org/10.1038/s41467-022-30615-x
- American Thoracic Society. (1999). Statement on Sarcoidosis; ATS/ERS/WASGOG. Am J Resp Crit Care Med. 1999; 160(3):736–755. Available from: www.atsjournals.org
- Bernstein M, Konzlemann FW, Sidlick DM. Boeck's sarcoid: report of a case with visceral involvement. Archives of Internal Medicine. 1929; 44(5):721-734.
- Sugai M, Murata O, Oikawa H, Katagiri H, Matsumoto A, Nagashima H, Sugai T, Maemondo M. A case of bone marrow involvement in sarcoidosis with crescentic glomerular lesions. Respiratory Medicine Case Reports. 2020;28 (31):101202. Available from: https://doi.org/10.1016/j.rmcr. 2020.101202
- Soto-Gomez N, Peters JI, Nambiar AM. Diagnosis and management of sarcoidosis. American Family Physician. 2016; 93(10):840–848.
- Rahaghi FF, Baughman RP, Saketkoo LA, Sweiss NJ, Barney JB, Birring SS, Costabel U, Crouser ED, Drent M, Gerke AK, Grutters JC, Hamzeh NY, Huizar I, James WE, Kalra S, Kullberg S, Li H, Lower EE, Maier LA, Scholand MB. Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis. European Respiratory Review. 2020; 29(155). Available from: https://doi.org/10.1183/16000617.0146-2019
- Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, Du Bois R, Albera C, Brutsche M, Davis G, Donohue JF, Müller-Quernheim J, Schlenker-Herceg R, Flavin S, Lo KH, Oemar B, Barnathan ES. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. American Journal of Respiratory and Critical Care Medicine. 2006; 174(7):795–802. Available from: https://doi.org/10.1164/rccm.200603-402OC
- Kowalska M, Niewiadomska E, Zejda JE. Epidemiology of sarcoidosis recorded in 2006-2010 in the silesian voivodeship on the basis of routine medical reporting. Annals of Agricultural and Environmental Medicine. 2014; 21(1):55–58.
- Brito-Zerón P, Sellarés J, Bosch X, Hernández F, Kostov B, Sisó-Almirall A, Casany CL, Santos JM, Paradela M, Sanchez M, Ramírez J, Xaubet A, Agustí C, Ramos-Casals M. (2016). Epidemiologic patterns of disease expression in sarcoidosis: Age, gender and ethnicity-related differences. Clinical and Experimental Rheumatology. 2016; 34(3):380–388.
- Nagai S, Yokomatsu T, Tanizawa K, Ikezoe K., Handa T, Ito Y, Ogino S, Izumi T. Treatment with methotrexate and low-dose corticosteroids in sarcoidosis patients with cardiac lesions. Internal Medicine. 2014; 53(5):427–433. Available from: https://doi.org/10.2169/internalmedicine.53.0794
Unusual Clinical Presentation of Sarcoidosis with Thrombocytopenia, Bone Marrow Involvement, and Myocardial Infiltration: A Case Report
Öz
This case study describes a 67-year-old female patient who presented with shortness of breath and quick exhaustion. In 2018, initial symptoms led to a diagnostic thoracic CT scan, which confirmed sarcoidosis using endobronchial ultrasound (EBUS). Despite the diagnosis, the patient did not receive treatment. A 2023 bone marrow biopsy revealed that the disease had progressed to include heart failure and thrombocytopenia. Transthoracic echocardiography (TTE) was used for cardiological examination, which revealed impaired left ventricular wall motion. Magnetic resonance imaging (MRI) revealed severe cardiac involvement by detecting full-thickness late gadolinium enhancement (LGE) in the left ventricle. This case report emphasizes the complexity and diversity of sarcoidosis symptoms, supporting a multidisciplinary approach for correct diagnosis and individual treatment approach.
Anahtar Kelimeler
Sarcoidosis Thrombocytopenia Myocardial Infiltration Bone Marrow Involvement
Kaynakça
- Arkema EV, Grunewald J, Kullberg S, Eklund A, Askling J. Sarcoidosis incidence and prevalence: A nationwide register-based assessment in Sweden. European Respiratory Journal. 2016; 48(6):1690–1699. Available from: https://doi.org /10.1183/13993003.00477-2016
- Rossides M, Darlington P, Kullberg S, Arkema EV. Sarcoidosis: Epidemiology and clinical insights. Journal of Internal Medicine. 2023; 293(6):668–680. Available from: https:// doi.org/10.1111/joim.13629.
- Damsky W, Wang A, Kim DJ, Young BD, Singh K, Murphy MJ, Daccache J, Clark A, Ayasun R, Ryu C, McGeary MK, Odell ID, Fazzone-Chettiar R, Pucar D, Homer R, Gulati M, Miller EJ, Bosenberg M, Flavell RA, King B. Inhibition of type 1 immunity with tofacitinib is associated with marked improvement in longstanding sarcoidosis. Nature Communications. 2022; 13(1):1–17. Available from: https://doi.org/10.1038/s41467-022-30615-x
- American Thoracic Society. (1999). Statement on Sarcoidosis; ATS/ERS/WASGOG. Am J Resp Crit Care Med. 1999; 160(3):736–755. Available from: www.atsjournals.org
- Bernstein M, Konzlemann FW, Sidlick DM. Boeck's sarcoid: report of a case with visceral involvement. Archives of Internal Medicine. 1929; 44(5):721-734.
- Sugai M, Murata O, Oikawa H, Katagiri H, Matsumoto A, Nagashima H, Sugai T, Maemondo M. A case of bone marrow involvement in sarcoidosis with crescentic glomerular lesions. Respiratory Medicine Case Reports. 2020;28 (31):101202. Available from: https://doi.org/10.1016/j.rmcr. 2020.101202
- Soto-Gomez N, Peters JI, Nambiar AM. Diagnosis and management of sarcoidosis. American Family Physician. 2016; 93(10):840–848.
- Rahaghi FF, Baughman RP, Saketkoo LA, Sweiss NJ, Barney JB, Birring SS, Costabel U, Crouser ED, Drent M, Gerke AK, Grutters JC, Hamzeh NY, Huizar I, James WE, Kalra S, Kullberg S, Li H, Lower EE, Maier LA, Scholand MB. Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis. European Respiratory Review. 2020; 29(155). Available from: https://doi.org/10.1183/16000617.0146-2019
- Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, Du Bois R, Albera C, Brutsche M, Davis G, Donohue JF, Müller-Quernheim J, Schlenker-Herceg R, Flavin S, Lo KH, Oemar B, Barnathan ES. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. American Journal of Respiratory and Critical Care Medicine. 2006; 174(7):795–802. Available from: https://doi.org/10.1164/rccm.200603-402OC
- Kowalska M, Niewiadomska E, Zejda JE. Epidemiology of sarcoidosis recorded in 2006-2010 in the silesian voivodeship on the basis of routine medical reporting. Annals of Agricultural and Environmental Medicine. 2014; 21(1):55–58.
- Brito-Zerón P, Sellarés J, Bosch X, Hernández F, Kostov B, Sisó-Almirall A, Casany CL, Santos JM, Paradela M, Sanchez M, Ramírez J, Xaubet A, Agustí C, Ramos-Casals M. (2016). Epidemiologic patterns of disease expression in sarcoidosis: Age, gender and ethnicity-related differences. Clinical and Experimental Rheumatology. 2016; 34(3):380–388.
- Nagai S, Yokomatsu T, Tanizawa K, Ikezoe K., Handa T, Ito Y, Ogino S, Izumi T. Treatment with methotrexate and low-dose corticosteroids in sarcoidosis patients with cardiac lesions. Internal Medicine. 2014; 53(5):427–433. Available from: https://doi.org/10.2169/internalmedicine.53.0794
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Hizmetleri ve Sistemleri (Diğer) |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Haziran 2024 |
| Gönderilme Tarihi | 27 Aralık 2023 |
| Kabul Tarihi | 21 Mayıs 2024 |
| Yayımlandığı Sayı | Yıl 2024 |