Sarcoidosis at the Pulmonary Medicine Department of a tertiary care hospital in Mumbai. Our experience and The New Modified Criteria Clinical Radiological Physiological (TNMC CRP) score for sarcoidosis: A novel proposition to assess the functional status
Sarcoidosis is a multisystemic granulomatous disease most commonly involving the pulmonary system and having a myriad of manifestations. However literature is scanty pertaining to the profile and scoring system in sarcoidosis. This study was undertaken to understand the profile of sarcoidosis and an endeavor to assess the functional status with a simplified scoring system. This was an observational study undertaken in the department of Pulmonary Medicine at a tertiary care. The profile of these patients was studied in terms of clinical features, radiological findings, the New Modified Criteria Clinical Radiological Physiological (TNMC CRP) score, six-minute walk distance (6MWD), spirometry, arterial blood gas parameters, serum angiotensin converting enzyme (ACE) levels and tissue biopsy histopathology. The 68 patients included 41 women and 27 men with a mean age of 42.7 years. They comprised of 18 (27%), 39 (57%), 4 (6%), 7 (10%) cases of stage 1, 2, 3, 4 sarcoidosis respectively. Most common presenting symptom and sign was progressive dyspnea 49 (72%), and peripheral lymphadenopathy 15 (22%). Serum ACE was elevated in 57 (83%). The average 6MWD was 360 meters. Most common high resolution computed tomography (HRCT) finding was mediastinal lymphadenopathy and peri-bronchovascular nodules. Spirometry was restrictive abnormality in 48 (96%) patients. Evidence of pulmonary hypertension (PH) was present in 32 (47%) patients. Tissue diagnosis revealed granulomatous inflammation in 51 biopsies with a transbronchial lung biopsy (TBLB) yield of 62%. The average TNMC CRP score was 5. There was a positive correlation between this score and 6MWD which was statistically significant. The score correlated with the functional status. Diagnosis of sarcoidosis warrants a comprehensive and multimodality approach. HRCT and tissue biopsy are the most important diagnostic armamentariums. Modified simplified scores help assess the functional status of the disease.
Baughman RP, Lower EE, du Bois RM. Sarcoidosis. Lancet 2003;361:1111‑8.
Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007;357:2153-65.
Nunes H, Soler P, Valeyre D. Pulmonary sarcoidosis. Allergy 2005;60:565‑82.
Sharma SK, Mohan A. Sarcoidosis in India: Not so rare! J Indian Acad Clin Med 2004;5:12-21.
Alhamad EH. The six-minute walk test in patients with pulmonary sarcoidosis. Ann Thorac Med 2009;4:60-4.
Kumar R, Goel N, Gaur SN. Sarcoidosis in north Indian population: A retrospective study. Indian J Chest Dis All Sci 2012;54:99-104.
Jindal SK, Gupta D, Aggarwal AN. Sarcoidosis in developing countries. Curr Opin Pulm Med 2000;6:448-54.
Sharma SK, Mohan A, Guleria JS. Clinical characteristics, pulmonary function abnormalities and outcome of prednisolone treatment in 106 patients with sarcoidosis. J Assoc Physicians India 2001;49:697-704
Behbehani N, JayKrishnan B, Khadadah M, et al. Clinical presentation of sarcoidosis in a mixed population in the middle east. Respir Med 2007;101:2284-8.
Nunes H, Bouvry D, Soler P, Valeyre D. Sarcoidosis. Orphanet J Rare Dis 2007;2:46.
Yanardag H, Caner M, Papila I, et al. Diagnostic value of peripheral lymph node biopsy in sarcoidosis: A report of 67 cases. Can Respir J 2007;14:2209-116.
Sarkar M, Mahesh D, Madabhavi I. Digital clubbing. Lung India 2012;29:354.
Lieberman J. Elevation of serum angiotensin-converting-enzyme (ACE) level in sarcoidosis. Am J Med1975;59:365-72.
Baughman RP, Teirstein AS, Judson MA, et al. A Case Control Etiologic Study of Sarcoidosis (ACCESS) research group. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001;164:1885–9.
Ors F, Gumus S, Aydogan M, et al. HRCT findings of pulmonary sarcoidosis; relation to pulmonary function tests. Multidiscip Respir Med 2013;8:8.
Criado E, Sánchez M, Ramírez J, et al. Pulmonary sarcoidosis: Typical and atypical manifestations at high-resolution CT with pathologic correlation. RadioGraphics 2010;30:1567-86.
Murdoch J, Müller NL. Pulmonary sarcoidosis: changes on follow-up CT examination. Am J Roentgenol 1992;159:473-7.
Teirstein AS, Machac J, Almeida O, et al. Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis. Chest 2007;132:1949-53.
Silva L, Hertz F, Cruz D, et al. [Sarcoidose no sul do Brasil: estudo de 92 pacientes].[Article in Portuguese]. J Bras Pneumol 2005;31:398-406.
Darlington P, Gabrielsen A, Sörensson P, et al. Cardiac involvement in Caucasian patients with pulmonary sarcoidosis. Respir Res 2014;15:15.
Sulica R, Teirstein AS, Kakarla S, et al. Distinctive clinical, radiographic, and functional characteristics of patients with sarcoidosis-related pulmonary hypertension. Chest 2005;128:1483.
Mahapatra QS, Sahai K, Rathi KR, et al. Pulmonary sarcoidosis: An important differential diagnosis in transbronchial lung biopsies. Lung India 2014;31:139-41.
Soares RV, Forsythe A, Hogarth K, et al. Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment. Arq Gastroenterol 2011;48:91-7.
Westney GE, Habib S, Quarshie A. Comorbid illnesses and chest radiographic severity in African-American sarcoidosis patients. Lung 2007;185:131-7.
Martusewicz-Boros MM, Boros PW, Wiatr E, Roszkowski-Śliż K. What comorbidities accompany sarcoidosis? A large cohort (n=1779) patients analysis. Sarcoidosis Vasc Diffuse Lung Dis 2015;32:115-20.
Turner GA, Lower EE, Corser BC, et al. Sleep apnea in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 1997;14:61-4.
Okumus G, Musellim B, Cetinkaya E, et al. Extrapulmonary involvement in patients with sarcoidosis in Turkey. Respirology 2011;16:446-50.
Chung YM, Lin YC, Liu YT, et al. Uveitis with biopsy-proven sarcoidosis in Chinese--a study of 60 patients in a uveitis clinic over a period of 20 years. J Chin Med Assoc 2007;70:492-6.
Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and detection of sarcoidosis. An official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020;201:e26-51.
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