Cardiac Involvement in Sarcoidosis Deaths in Wayne County, Michigan

Background: Sarcoidosis is a disease of unknown etiology characterized by the formation of noncaseating, nonnecrotizing granulomas in various organ systems. Methods: Reviews of 84 cases of natural death with sarcoidosis between the years 1996 and 2017 autopsied at Wayne County. Results: The median age of decedents was 44 years (29 – 59 years of age). Blacks comprised 95% of the cohort, and 52% were female. Sarcoidosis or direct sequelae were the cause of death in 79% of cases. Twenty-nine percent of patients had a documented history of sarcoidosis and 70% of patients had evidence of systemic sarcoidosis. The most common sites of involvement were lungs or hilar lymph nodes (92%), heart (45%), liver (39%), and spleen (30%). Decedents with cardiac involvement were more likely to have no documented history of sarcoidosis (87% vs. 59%, p=0.004), more likely to have died of a sarcoidosis-related cause (97% vs. 65%, p<0.001), and died at a younger mean age (41 years vs. 46 years, p=0.001). In addition, individuals with cardiac involvement commonly had concurrent multiorgan involvement including lungs (90%), lymph nodes (38%), liver (40%), spleen (32%), and kidneys (7%). Conclusions: Cardiac sarcoidosis is a uniquely poor prognostic factor and carries an increased risk of sudden death as shown by a disproportionate representation among medical examiner cases of sarcoidosis. Our findings suggest that approximately 40% may have asymptomatic cardiac involvement. The distribution of sarcoidosis within our cohort suggests that there is potentially a large undiagnosed and/or underdiagnosed demographic within large urban centers, such as Detroit, Michigan.

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A Case of Sarcoidosis Disseminated to Skeletal Tissues

International Journal of Medical Students ◽

10.5195/ijms.2013.30 ◽

2013 ◽

Vol 1 (1) ◽

pp. 43-45

Author(s):

Edon Rabinowitz ◽

Chinwe Ogedegbe ◽

Joseph Feldman

Keyword(s):

Cell Tumor ◽

Unknown Etiology ◽

Granulomatous Disease ◽

Presenting Symptoms ◽

Organ Systems ◽

Mediastinal Germ Cell Tumor ◽

History Of ◽

Hilar Adenopathy ◽

Eye Lesions ◽

Musculoskeletal Involvement

Sarcoidosis is a systemic granulomatous disease of unknown etiology that typically affects young adults. Diagnostic criteria for sarcoidosis include involvement of two or more of the following organ systems: 1) pulmonary infiltrates; 2) bilateral hilar adenopathy; and 3) skin and/or eye lesions. Musculoskeletal system is less commonly involved. For that reason potential presenting symptoms can vary and make the diagnosis very challenging; particularly if a patient has symptoms that mimic other conditions. Musculoskeletal involvement for example can mimic malignancy. The following case describes a patient with known history of primary metastatic mediastinal Germ Cell Tumor (GCT) with teratomatous elements who is diagnosed with sarcoidosis involving skeletal tissues.

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Ventricular tachycardia storm management in a COVID-19 patient: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa217 ◽

2020 ◽

Vol 4 (FI1) ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Gianfranco Mitacchione ◽

Marco Schiavone ◽

Alessio Gasperetti ◽

Giovanni B Forleo

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Arrhythmias ◽

Cardiac Involvement ◽

Previous History ◽

Left Ventricular ◽

Electrical Storm ◽

Increased Risk ◽

History Of ◽

Myocardial Involvement ◽

Artery Disease

Abstract Background Coronavirus disease 2019 (COVID-19) has been associated with myocardial involvement. Among cardiovascular manifestations, cardiac arrhythmias seem to be fairly common, although no specifics are reported in the literature. An increased risk of malignant ventricular arrhythmias and electrical storm (ES) has to be considered. Case summary We describe a 68-year-old patient with a previous history of coronary artery disease and severe left ventricular systolic disfunction, who presented to our emergency department describing cough, dizziness, fever, and shortness of breath. She was diagnosed with COVID-19 pneumonia, confirmed after three nasopharyngeal swabs. Ventricular tachycardia (VT) storm with multiple implantable cardioverter defibrillator (ICD) shocks was the presenting manifestation of cardiac involvement during the COVID-19 clinical course. A substrate-based VT catheter ablation procedure was successfully accomplished using a remote navigation system. The patient recovered from COVID-19 and did not experience further ICD interventions. Discussion To date, COVID-19 pneumonia associated with a VT storm as the main manifestation of cardiac involvement has never been reported. This case highlights the role of COVID-19 in precipitating ventricular arrhythmias in patients with ischaemic cardiomyopathy who were previously stable.

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Effect of Prior History of Dementia and a Diagnosis of COVID-19 on Delirium in the ICU

Proceedings of IMPRS ◽

10.18060/24685 ◽

2020 ◽

Vol 3 ◽

Author(s):

Amira Kupty ◽

Fen-Lei Chang

Keyword(s):

Retrospective Chart Review ◽

Multiple Organ ◽

Prior History ◽

Organ Systems ◽

Increased Risk ◽

History Of ◽

Recent Diagnosis ◽

Potential Factors ◽

Icu Delirium ◽

Severity Of Dementia

Background: Delirium occurred in nearly two out of every three patients in the ICU from prior studies. It is associated with poor health outcomes, including long-term cognitive and motor decline, increased risk of dementia, and increased mortality. In the context of COVID-19, patients are more likely to develop delirium due to the severity of the illness involving multiple organ systems. Our study evaluates factors contributing to the occurrence of delirium in the ICU for patients with or without a history of dementia and with or without a recent diagnosis of COVID-19. Methods: We performed a retrospective chart review of ICU patients in Fort Wayne, IN from January through the end of June of 2020. Patients were grouped by whether they developed delirium or not and whether they had pre-existing dementia. We recorded age, sex, race, BMI, level of education, high risk medications, comorbidities, enteric/NPO feeding, mechanical ventilation, mobility, and lab results including CBC and BMP at the onset of delirium. Additionally, we included severity of delirium, length of stay, functional status at time of discharge, and COVID-19 status. Results: We were unable to collect data at the time. However, we hypothesized that the incidence and severity of ICU delirium is associated with the severity of dementia and COVID status, among other factors. Potential Impact: This study can shed light on the contribution of dementia history to ICU delirium and potential factors contributing to delirium incidence and severity. The COVID pandemic offers opportunities to differentiate effects of neurological (dementia) versus non-neurological factors (respiratory, renal, cardiovascular, and metabolic) on ICU delirium.

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Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab

Pediatric Rheumatology ◽

10.1186/s12969-021-00549-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Megan Trainor ◽

Emily Henkel ◽

Lucia Z. Diaz ◽

Ruy Carrasco

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Cell Mediated Immunity ◽

Close Monitoring ◽

X Rays ◽

Coccidioides Immitis ◽

Dimorphic Fungus ◽

Organ Systems ◽

Increased Risk ◽

Pulmonary Manifestations ◽

History Of

Abstract Background Coccidioides immitis is a dimorphic fungus endemic to the arid climates of the Southwest United States, Mexico and parts of Central and South America. Human infection occurs through inhalation of spores with less than half of exposures progressing to a symptomatic state that primarily consists of pulmonary manifestations. Disseminated coccidioidomycosis is exceedingly rare, occurring in fewer than 1 % of symptomatic infections. Through hematogenous spread, the fungus can infect most organ systems and may be fatal without systemic antifungal treatment. Individuals with impaired cell-mediated immunity either from primary immunodeficiency disorders or secondary to immunosuppression with medications such as tumor necrosis factor alpha (TNF-α) inhibitors have increased risk of disseminated coccidioidomycosis and previous cases of coccidioidomycosis have been reported with biologic therapy. Case presentation We present a case of disseminated coccidioidomycosis in a 16-year-old female with polyarticular juvenile idiopathic arthritis (JIA) being treated with prednisone, methotrexate, and infliximab. The patient presented with symptoms of meningeal irritation, bilateral choroidal lesions, and necrotizing peripheral pneumonia. Her infection was thought to be a reactivation of coccidioidomycosis given her history of resolved pneumonia that occurred after traveling to Arizona, New Mexico, and El Paso one year prior to presentation. Following diagnosis, she improved with discontinuation of her immunosuppressive medications and two weeks of intravenous amphotericin B and fluconazole with plans for lifetime treatment with fluconazole while immunosuppressed. Due to worsening arthritis, she will begin tofacitinib and continue close monitoring of chest x-rays and coccidioides antibody. Conclusions Patients undergoing immunosuppressive therapy for rheumatological conditions are at increased risk of disseminated coccidioidomycosis and should be evaluated with high suspicion when presenting with atypical symptoms and history of travel to endemic regions.

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Aortic Thrombus Embolization in A Patient with Tuberous Sclerosis

Journal of Pediatric Neurology ◽

10.1055/s-0041-1739261 ◽

2021 ◽

Author(s):

Steven Wolf ◽

Andrew Rhoads ◽

William Gomes ◽

Philip Overby ◽

Patricia McGoldrick

Keyword(s):

Cerebral Infarction ◽

Tuberous Sclerosis ◽

Genetic Disorder ◽

Altered Mental Status ◽

Unknown Etiology ◽

Benign Tumors ◽

Organ Systems ◽

Aortic Thrombus ◽

History Of ◽

The Right

AbstractTuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder affecting many organ systems. Patients commonly develop a variety of benign tumors as well as neurological disease, including seizures, autism, and cognitive delay. We report here the case of an adolescent patient with TSC and a history of mild COVID-19 who presented with a 1-day history of altered mental status. The patient was found to have ischemic cerebral infarction of the right MCA and ACA territories. Initial angiography showed an occlusion of the right internal carotid artery without a demonstrable etiology, with follow-up echocardiography and angiography revealing a large aortic thrombus. The patient was not a candidate for thrombus removal due to her cerebral infarct and received medical anticoagulation. Thrombosis progressed to involve the left ICA, with left cerebral infarction and subsequent death. Aortic thrombus embolization as a cause of cerebrovascular accident (CVA) is a novel finding in the setting of TSC and should be considered for pediatric patients with CVA of unknown etiology. It is unclear whether this was related to the prior COVID-19 infection.

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Cardiac involvement in genetic disease

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0362 ◽

2020 ◽

pp. 3551-3558

Author(s):

Thomas A. Traill

Keyword(s):

Family History ◽

Connective Tissue ◽

Marfan Syndrome ◽

Genetic Disease ◽

Cardiac Involvement ◽

Connective Tissue Disorders ◽

Cardiac Defects ◽

Or Management ◽

Organ Systems ◽

History Of

Many clinicians find themselves faced, from time to time, with a patient who has a family history of a known disorder, such as Marfan syndrome, or who has non-cardiac features that suggest a syndrome. The first part of this chapter deals with developmental syndromes that include congenital cardiac defects, with coverage restricted to a few relatively common disorders that are seen in adult patients. The second part describes the two common connective tissue disorders—Marfan and Ehlers–Danlos syndromes—and the more recently described Loeys–Dietz syndrome that shares some pathogenetic mechanisms with Marfan. Some other heritable diseases that affect the heart are listed in a table, without discussion in the text: though they are important to other organ systems, they offer little opportunity to the cardiologist for diagnosis or management.

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Effect of cholangitis on pre-operative evaluation of regional lymphadenopathy by CT in pancreato-biliary malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15651 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15651-e15651

Author(s):

Abhijit Chandra ◽

Vivek Gupta ◽

Saket Kumar ◽

Pradeep Joshi ◽

Vishal Gupta ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Periampullary Cancer ◽

Regional Lymph Nodes ◽

Poor Prognostic Factor ◽

Lymph Node Size ◽

Ct Evaluation ◽

History Of ◽

Biliary Malignancies ◽

Node Size

e15651 Background: Regional lymph nodes metastasis is a poor prognostic factor in pancreato-biliary malignancies. CT findings like lymph node size > 10mm, irregular shape, heterogenous enhancement, conglomeration and infiltration can suggest metastatic involvement. Cholangitis can induce reactive changes in regional lymph nodes. This study aimed to find if episodes of cholangitis interfere with the pre-operative CT evaluation of regional lymphadenopathy in pancreato-biliary malignancies. Methods: Regional lymph nodes metastasis is a poor prognostic factor in pancreato-biliary malignancies. CT findings like lymph node size > 10mm, irregular shape, heterogenous enhancement, conglomeration and infiltration can suggest metastatic involvement. Cholangitis can induce reactive changes in regional lymph nodes. This study aimed to find if episodes of cholangitis interfere with the pre-operative CT evaluation of regional lymphadenopathy in pancreato-biliary malignancies. Results: A total of 41 patients of gallbladder cancer and 20 patients of periampullary cancer were included. A total of 206 lymph node stations were sampled. In gallbladder cancer group, CT finding of lymph node size > 10mm, ill-defined borders and conglomeration; while intra-operative findings were node size > 10mm, hard consistency and necrosis on cut-section significantly predicted metastatic lymphadenopathy on univariate analysis. In multivariate analysis, size > 10mm measured intra-operatively was the only significant predictor of metastatic lymphadenopathy.21.9% patients (9/41) had history of cholangitis pre-operatively. In this subgroup, none of the CT characteristic or intra-operative nodal feature significantly predicted malignant involvement. In periampullary cancer, nodal necrosis on intra-operative cut-section was a significant predictor of malignant involvement in univariate, but not in multivariate analysis. Subgroup analysis of patients with history of cholangitis (10/20) did not reveal any significant pre-operative or intra-operative lymph nodal feature predicting malignant involvement. Conclusions: In patients with gallbladder or periampullary cancer with history of cholangitis, the typical CT characteristics or the intra-operative characteristics of regional lymph nodes cannot be relied on to predict metastatic lymph node involvement. Thus, cholangitis affects the clinical staging of these malignancies.

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Sepsis-like illness with mediastinal involvement after EUS-FNP of mediastinal lymph nodes in a patient with sarcoidosis and a history of esophageal carcinoma

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0033-1354968 ◽

2013 ◽

Vol 34 (S 01) ◽

Author(s):

W Bohle ◽

WG Zoller

Keyword(s):

Lymph Nodes ◽

Esophageal Carcinoma ◽

Mediastinal Lymph Nodes ◽

History Of ◽

Mediastinal Involvement

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Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00351 ◽

2020 ◽

Author(s):

Judd Sher ◽

Kate Kirkham-Ali ◽

Denny Luo ◽

Catherine Miller ◽

Dileep Sharma

Keyword(s):

Systematic Review ◽

At Risk ◽

Drug Therapy ◽

Dental Implant ◽

Case Series ◽

Cochrane Central Register ◽

Bisphosphonate Treatment ◽

Implant Placement ◽

Increased Risk ◽

History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

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