Sarcoidosis Presenting with Severe Thrombocytopenia

Kayar, Yusuf

doi:10.23937/2378-3516/1410056

Cited by 4 publications

(10 citation statements)

References 2 publications

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“…Interestingly, our patient showed no other cytopenia or splenomegaly, her peripheral smear was unremarkable, and there was no identified secondary cause, so primary ITP was assumed. Also, there was a good response to immunosuppression therapy, supporting an immune process causing platelet destruction [3,5] . There are no guidelines for the treatment of thrombocytopenia in sarcoidosis, but in light of the assumed physiopathological mechanism, steroids may be recommended as first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The literature identifies three main mechanisms for thrombocytopenia in sarcoidosis: (i) hypersplenism leading to platelet sequestration and destruction that should be suspected in a patient with splenomegaly and varying degrees of cytopenia (leukopenia, anaemia, thrombocytopenia); (ii) bone marrow granulomatous infiltration with consequent cytopenias; and (iii) autoimmunity with autoantibodies against platelets leading to increased peripheral destruction [ 2 , 3 ] . Several studies have found that severe thrombocytopenia in sarcoidosis is most probably secondary to an immune process [ 4 – 6 ] .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…There are no guidelines for the treatment of thrombocytopenia in sarcoidosis, but in light of the assumed physiopathological mechanism, steroids may be recommended as first-line treatment. However, in emergency situations with a severe bleeding risk, as in the presented case, it seems reasonable to apply the current guidelines recommended for ITP: methylprednisolone (1 g/day for 2 days) and/or IVIG (1 g/kg/day for 3 days) [ 3 , 4 ] .…”

Section: Discussionmentioning

confidence: 99%

“…Sarcoidosis is a multisystemic chronic granulomatous disease of unknown cause with a predilection for the lower respiratory tract [ 1 , 2 ] . Although haematological manifestations such as lymphopenia and anaemia are often detected, thrombocytopenia is a rare extrapulmonary complication (<1%) [ 3 ] and has been rarely reported as the initial clinical manifestation of sarcoidosis [ 4 ] . A French review of 20 patients with sarcoidosis and thrombocytopenia concluded that immune thrombocytopenia (ITP) could be severe and symptomatic at presentation but usually followed a favourable course without death or severe bleeding because of modern therapeutic management (mainly immunosuppressive therapy) [ 2 ] .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Immune Thrombocytopenia: A Rare Presentation of Pulmonary Sarcoidosis

Leal

Amado

Paracana

et al. 2021

European Journal of Case Reports in Internal Medicine

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Thrombocytopenia may be the initial presentation of sarcoidosis, which is a systemic granulomatous disorder. Various pathophysiological mechanisms have been identified. Immune thrombocytopenia often has a severe presentation but may respond favourably to immunosuppressive therapy. There are no guidelines for the treatment of thrombocytopenia in sarcoidosis. However, in emergency situations with major bleeding, it seems reasonable to apply the current guidelines recommended for immune thrombocytopenia. The authors report a case of sarcoidosis presenting with severe thrombocytopenia, petechial rash, and nasal and gingival bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Immune Thrombocytopenia: A Rare Presentation of Pulmonary Sarcoidosis

Leal

Amado

Paracana

et al. 2021

European Journal of Case Reports in Internal Medicine

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Sarcoidosis-Associated Immune Thrombocytopenic Purpura and Focal Segmental Glomerulosclerosis

Korogodina

Kaur

Kumthekar

2022

Journal of Investigative Medicine High Impact Case Reports

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Sarcoidosis is well known for heterogeneity of its presentation and multisystem organ involvement. It commonly involves respiratory tract, skin, eyes, and lymph nodes, as well as hematologic and renal systems. While anemia and lymphopenia are the most common hematologic abnormalities seen in sarcoidosis, immune thrombocytopenic purpura (ITP) is considered rare. Renal abnormalities, although infrequent, are usually more likely to involve tubules rather than glomeruli. In this report, we present a case of sarcoidosis-associated ITP and focal segmental glomerulosclerosis (FSGS), refractory to first-line therapy, but successfully treated with Rituximab and thrombopoietin-receptor agonist.

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A Rare Presentation of Sarcoidosis: Dysphagia, Pancytopenia, and Acute Renal Failure

Yadav¹,

Shah²,

Bachuwa³

2022

Cureus

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Sarcoidosis is a multisystem inflammatory chronic disorder that can virtually affect any organ system in the body. Most commonly affected organs are the intrathoracic structures with 90% of the reported cases involving the lungs. Esophageal involvement in sarcoidosis is extremely rare. Involvement of the esophagus and kidney along with hematological involvement is extremely uncommon in the same patient. Here, we present a case of a 58-year-old gentleman with a similar rare presentation. The patient presented with shortness of breath, productive cough, fatigue, and difficulty in swallowing, along with a weight loss of 20-30 pounds over three months. Laboratory workup was significant for leukopenia (2900 K/UL), serum creatinine level of 2.7 mg/dL (baseline: 1.2-1.7), and raised angiotensin-converting enzyme level at 187 nmol/ml/min. Chest X-ray showed bilateral widespread fine reticulonodular opacities, chest CT showed extensive bilateral reticulonodular opacities throughout the lung parenchyma, and fine-needle aspiration cytology of the right lung showed noncaseating granulomas. No fungal or acid-fast organisms were identified, and no evidence of malignancy was seen. Special stains for fungal (Grocott's methenamine silver and periodic acid-Schiff) and acid-fast organisms (acid-fast bacilli (AFB) and fluorescent AFB) were negative. Esophagogastroduodenoscopy (EGD) with gastric biopsy showed acute and chronic inflammation and no intestinal metaplasia, dysplasia, or malignancy was identified. Bronchoalveolar lavage was done, which showed macrophages (74%), neutrophils (6%), eosinophils (3%), and lymphocytes (17%), and was negative for malignant cells. QuantiFERON and AFB sputum/Mycobacterium tuberculosis polymerase chain reaction were negative. The patient was initially started on intravenous fluids and calcitonin, which significantly improved renal function and the calcium status of the body. Then prednisone 40 mg daily was started, which improved swallowing and breathing. After a week, prednisone was changed to 20 mg daily and was continued at the time of discharge.

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Sarcoidosis Presenting with Severe Thrombocytopenia

Cited by 4 publications

References 2 publications

Immune Thrombocytopenia: A Rare Presentation of Pulmonary Sarcoidosis

Immune Thrombocytopenia: A Rare Presentation of Pulmonary Sarcoidosis

Sarcoidosis-Associated Immune Thrombocytopenic Purpura and Focal Segmental Glomerulosclerosis

A Rare Presentation of Sarcoidosis: Dysphagia, Pancytopenia, and Acute Renal Failure

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