Sarcoid nodules

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). 

Sarcoid nodules sometimes tend to coalesce and form large parenchymal nodules with surrounding loosely aggregated small nodules. As the shape of these coalescent granulomas resembles a galaxy, it is referred... 

Skin A patient developed two histologically confirmed subcutaneous sarcoid nodules 15 months after starting adjuvant therapy with interferon for lymph node metastatic melanoma in which the primary tumor was not known [52" ]. As imaging techniques do... 

Wertheim MS, Mathers WD, Sublet EB, et al. Histopathological features of conjunctival sarcoid nodules using noninvasive in vivo confocal microscopy. Arch Ophthalmol 2005 123 274-276. 

Nakatsu M, Hatabu H et al. (2002) Large coalescent parenchymal nodules in pulmonary sarcoidosis sarcoid galaxy sign. AJR Am J Roentgenol 178 1389 1393 Nishimura K, Itoh H etal. (1993) Pulmonary sarcoidosis correlation of CT and histopathologic findings. Radiology 189 105 109... 

Figure 9 HRCT scan demonstrates dense alveolar consolidation, multiple nodules, sarcoid galaxies, and traction bronchiectasis. Note the cavitary lesion with a mycetoma. Abbreviation-. HRCT, high-resolution thin-section CT.

Muller NL, Miller RR. Ground-glass attenuation, nodules, alveohtis, and sarcoid granulomas. Radiology 1993 189(l) 31-32. 

Uveitis is the most common ocular manifestation of sarcoidosis in most series (4,5). Anterior uveitis occurs in 20% to 70% of patients with ocular sarcoidosis (4—6) and typically presents as an iritis or iridocyclitis (1,7). Symptoms include blurred vision, red eyes, painful eyes, and photophobia. However in one-third of patients, the patient may present without ocular symptoms. Therefore, all sarcoidosis patients require a slit-lamp and fundoscopic examination regardless of the presence of ocular symptoms. The slit-lamp examination may reveal mutton-fat keratic precipitates (Fig. 1), which are aggregates of inflammatory cells in the comeal epithelium (1,7). Other lesions of anterior sarcoid uveitis that may be seen with a slit lamp include Busacca nodules on the iris (Fig. 2) and Koeppe nodules on the papillary margin (8). Both these nodules are almost exclusively found when anterior sarcoid uveitis is a chronic condition (8). Chronic anterior sarcoid uveitis may cause cataracts and glaucoma. Since corticosteroid use can also lead to cataract formation and... 

All ocular inflammation from sarcoidosis requires treatment because it has the potential to cause permanent vision loss. Corticosteroids are the mainstay of treatment for ocular sarcoidosis (1). Topical corticosteroids (i.e., eye drops) may be used for the treatment of anterior uveitis. Mydriatics are always instilled to suppress the inflammation and avoid synechiae (adhesion of the iris to the lens) (1). Intraocular pressure must be monitored regularly because glaucoma may be the result of sarcoid trabecular nodules or the result of corticosteroid therapy (1). 

Specific sarcoid lesions most often are found on the head and neck but may occur symmetrically or asymmetrically on any part of the skin and mucosa (31). Almost all morphologies have been reported including macules, papules, patches, plaques, and nodules (31). 

---