Sarcoid

Asymptomatic or mildly ill patients and patients with sarcoid-like disease generally do not benefit from antifungal therapy. Therapy may be helpful in symptomatic patients whose conditions have not improved during the first month of infection. 

Unlabeled Uses To reduce frequency of recurrence of familial Mediterranean fever treatment of acute calcium pyrophosphate deposition, amyloidosis, biliary cirrhosis, recurrent pericarditis, sarcoid arthritis... 

Although colchicine is more specific in gout than the NSAIDs, NSAIDs (eg, indomethacin and other NSAIDs [except aspirin]) have replaced it in the treatment of acute gout because of the troublesome diarrhea sometimes associated with colchicine therapy. Colchicine is now used for the prophylaxis of recurrent episodes of gouty arthritis, is effective in preventing attacks of acute Mediterranean fever, and may have a mild beneficial effect in sarcoid arthritis and in hepatic cirrhosis. Although it can be given intravenously, this route should be used cautiously because of increased bone marrow toxicity. 

Relapsing polychondritis Progressive systemic sclerosis Sarcoid angiitis... 

Sarcoid affects the cerebral vessels only rarely, usually causing a generalized encephalopathy rather than focal features owing to ischemia or hemorrhage (Zajicek 2000 Gullapalli and Phillips 2004 Spencer et al. 2005). 

Sarcoid-like NSAIDs or corticosteroids can be of benefit for some patients... 

Reijula K, Sutinen S, Tuuponen T, Lahti R, Karkola P Pulmonary fibrosis, with sarcoid granulomas and angiitis, associated with handling of mouldy lichen. Eur J Respir Dis 1983 64 625-629. Yoshida K, Ueda A, Yamasaki H, Sato K, Uchida K, Ando M Hypersensitivity pneumonitis resrrlt-ing from A. fumigatus in a greenhouse. Arch Environ Health 1993 48 260-262. 

Tekeste, H., Latour, F., Levitt, R.E. Portal hypertension complicating sarcoid liver disease case report and review of the literature. Amer. J. Gastroenterol. 1984 79 389 - 396... 

Fig. 21.9 Sarcoid granulomas (miliary type, up to the size of a lentil) on the liver surface (right liver lobe)...

Blich, M., Edoute, Y. Clinical manifestations of sarcoid liver disease. X Gastroenterol. Hepatol. 2004 19 732-737... 

The early impression that interferon alfa, alone or in combination with ribavirin, could reactivate or cause new subcutaneous sarcoid nodules and pulmonary or generalized sarcoidosis, has been confirmed by several reports, with prompt recovery after interferon alfa withdrawal (SED-13, 1097) (SEDA-20, 330) (SEDA-22, 404). The incidence may have been underestimated in one series, 3 patients out of 60 who received interferon alfa alone or combined with ribavirin developed pulmonary sarcoidosis (351). In a review of 27 cases, the time to onset was 15 days to 30 months, and there were dermatological signs in 50% (352). Five patients had also taken ribavirin, but an enhanced T cell immune reaction from the combination of interferon alfa plus ribavirin is speculative. However, the association of cutaneous or systemic sarcoidosis with interferon alfa, alone or in association with ribavirin, has been exemplified by various reports (353,354), including one patient whose sarcoidosis resolved with prednisone despite continued interferon alfa treatment (355). 

A 60-year-old woman receiving interferon alfa developed cutaneous sarcoid foreign body granulomas at the sites of a previously childhood skin injury (356). 

This suggests that interferon alfa may facilitate the development of cutaneous sarcoid granuloma from particulate foreign matter. 

Eberlein-Konig B, Hein R, Abeck D, Engst R, Ring J. Cutaneous sarcoid foreign body granulomas developing in sites of previous skin injury after systemic interferon-alpha treatment for chronic hepatitis C. Br J Dermatol 1999 140(2) 370-2. 

Noguchi K, Enjoji M, Nakamuta M, Sugimoto R, Kotoh K, Nawata H. Various sarcoid lesions in a patient induced by interferon therapy for chronic hepatitis C. J Clin Gastroenterol 2002 35(3) 282-4. 

Granulomatous dermatitis with disseminated pruritic papules and histological features resembling those of sarcoid granulomas has been described in a 57-year-old man who received interferon beta-lb (58). The first lesions were observed after 2 months of treatment, persisted for 2 years, and slowly improved after interferon beta withdrawal and treatment with hydroxychloroquine PUVA. 

Mehta CL, Tyler RJ, Cripps DJ. Granulomatous dermatitis with focal sarcoidal features associated with recombinant interferon beta-lb injections. J Am Acad Dermatol 1998 39(6) 1024-8. 

Pyogenic granuloma Rosacea-like eruption Ruptured striae atrophicae Sarcoid-like granulomas (SEDA-19, 157)... 

Lem, V.M., Lipscomb, M.F., Weissler, J.C., Nunez, G., Ball, E.J., Stastny, P. and Toews, G.B. (1985). Bronchoalveolar cells from sarcoid patients demonstrate enhanced antigen presentation. J. Immunol. 135, 1766-1771. 

Inflammatory diseases e.g., myocarditis, e.g., with parvovirus B19, Kawasaki disease, sarcoid, smallpox vaccination, or myocardial extension of PE... 

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