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Sarcoidosis is a generalised granulomatous disorder of unknown aetiology. Cardiac involvement may affect conduction system, myocardium, valvular apparatus and pericardium. Clinical spectrum ranges from asymptomatic involvement to sudden cardiac death. Patients with biopsy-proven extracardiac sarcoidosis should be screened for cardiac involvement (standard ECG, 24-hour Holter ECG, echocardiography) and in case of any abnormalities found on these tests, more advanced diagnostic methods should be used. Steroid treatment is still the mainstay of therapy in cardiac sarcoidosis. Several immunosuppresive agents are also effective and used in different combinations with steroids, as well as heart failure treatment (including ACE inhibitors, angiotensin receptor blockers, beta-blockers and diuretics). Advanced heart block requires pacemaker implantation, and implantable cardioverterdefibrillator is an effective treatment in primary and secondary prophylaxis of sudden cardiac death. Heart transplantation is considered in advanced, drug-resistant heart failure or incessant ventricular arrhythmias unresponsive to other forms of therapy., (© 2018 MEDPRESS.)

The role of vitamin D in the human body is not limited only to the regulation of calcium metabolism and secondary to the impact on bones. Recent studies have shown the influence of vitamin D level on muscles, on the risk of cancer, diabetes, hypertension and pulmonary diseases, including granulomatous diseases. Sarcoidosis is a granulomatous disease of unknown etiology. Hypercalcemia in the course of the disease occurs in up to 10% of cases in the consequence of autonomous overproduction of 1,25-dihydroxyvitamin D by macrophages of sarcoid granulomas. Hypercalciuria occurs 3-fold more frequent. On the other hand, treatment with corticosteroids increases the risk of osteoporosis. Vitamin D intake is recommended for prevention of osteoporosis. Such management, in sarcoidosis patients, is not so clear because of risk of hypercalcemia. Vitamin D supplementation, according to current recommendations for general population, is based solely on 25-hydroxyvitamin D level testing. This seems to be not safe in the group of sarcoidosis patients. This article discusses the role of vitamin D in sarcoidosis patients and current opinion on vitamin D supplementation in this group., (© 2018 MEDPRESS.)

Sarcoidosis is a systemic granulomatous disease of unknown aetiology. The course of sarcoidosis ranges from asymptomatic to severe. It could affect people of all ages. The disease affects predominantly the lungs and lymph nodes, skin, abdominal organs or eyes. Sarcoidosis of lacrimal sac is very uncommon. We describe a young man with lacrimal sac and nasal mucosa sarcoidosis present with epiphora. Few years before the onset of dacriocystitis the patient was treated because of lymph nodes sarcoidosis. The lacrimal sac sarcoidosis developed five years after systemic disease remission. An endoscopic dacriocystorhinostomy with intubation of nasolacrimal duct was performed. We used postoperatively systemic and local steroids for 3 months period. The patient is under observation for over four years with good health. The abnormal looking nasal or lacrimal sac mucosa could be associated with granulomatous disease as sarcoidosis and Wegener's or malignancies. If the sarcoidosis is established, it could be the first manifestation of sarcoidosis leading to future systemic sarcoidosis development or it may develop many years after the onset of systemic disease. Endoscopic dacriocystorhinostomy with intubation followed by intensive therapy with systemic and local corticosteroids may be helpful to maintain lacrimal drainage patency., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Fibrosing mediastinitis is a rare disease, mostly associated with previous granulomatous diseases, such as histoplasmosis, tuberculosis, or sarcoidosis. We present a case of 42-year-old woman with sarcoidosis, who had developed fibrosing mediastinitis and pulmonary hypertension. Contrast-enhanced computer tomography showed abnormal, bilateral, solid tissues surrounding the hila and mediastinum. Magnetic resonance imaging showed: abnormal, intermediate signal tissue in the mediastinum, surrounding hila, narrowing both lower lobe arteries and both lobe bronchi, left upper lobe atelectasis, and contrast enhancement of mediastinal infiltration. The patient was treated with steroids for 14 months (initial dose of prednisone was 1 mg/kg/day, then tapered) with clinical and radiological improvement. We reviewed the literature concerning fibrosing mediastinitis. The various causes of that disorder, the radiological manifestation, and possible treatment modalities are discussed. The causes of pulmonary hypertension in our patient are another aspect of the article. It could be associated with both the fibrosing mediastinitis and the sarcoidosis.

Clinical involvement of the nervous system occurs in about 5% of patients with sarcoidosis. We describe a fatal case of a young patient with neurosarcoidosis with a relatively rare psychotic syndrome in the course of neurosarcoidosis, presenting itself as a depressive syndrome with delusions. The neurological manifestations consisted of cerebellar symptoms, peripheral neuropathy and general epileptic seizures. Cerebrospinal fluid examination, serum angiotensin-converting enzyme level, magnetic resonance imaging, chest radiography, gallium isotope scanning and other tests were used as diagnostic tools. He was treated with steroids, methotrexate and neuroleptics ineffectively. The patient died because of complications related to neurosarcoidosis. The diagnosis of neurosarcoidosis was confirmed by autopsy.

Gastrointestinal sarcoidosis is very rare manifestation of the illness. This article presents patient who had been diagnosed for several months because of abdominal pain, vomiting and significant weight loss. Numerous gastric endoscopy examinations showed the difficult healing ulcers in the stomach, progressive thickening of the mucosal folds with narrowing of the lumen, lack of peristalsis and the rigidity of the walls. Histological examination of the specimen of the ventricular mucosa revealed chronic inflammation, as well as suspicion of tumor infiltration. Finally gastric sarcoidosis has been diagnosed on the basis of CT with double contrast, and histopathological examination of biopsis of stomach collected during laparotomy.

Purpose: Inflammation of retinal vessels occures in variety of ophthalmic and systemic conditions. In this paper we attempt to reconstruct the events that lead to retinal vessels inflammation., Material and Methods: We have studied 30 patients (14 F, 16 M)(age 27-54 years) with retinal vessels inflammation. 25 have additionally uveitis during 2 weeks to 21 years. In 7 cases etiology was established (sarcoidosis, tuberculosis, toxoplasmosis, systemic lupus erythematosus, hepatitis C). All patients were evaluated with ophthalmoscopic fundus examination. In some cases fluoresceine angiography and magnetic resonance imaging (MRI) was obtained. We are looking for the systemic, parasites and demyelination disorders., Results and Conclusions: Exact etiology was recognized in 5 patients (Ealse disease, sarcoidosis, SM). In 10 patients retinal vascullitis was connected with changes in central nervous system.

Cardiac involvement in sarcoidosis may be incidentally discovered without any symptoms of the disease. When undiagnosed and untreated it is potentially fatal. Although there is no recommended strategy for the diagnosis, the introduction of newer technology is promising and may be useful for early diagnosis of sarcoid heart disease and for the evaluation of response to therapy. We present a case of 53-years old woman, with asymptomatic cardiac arrhythmias and x-ray chest picture changes without any respiratory symptoms. Further assessment and the use of cardiac magnetic resonance imaging allowed a diagnosis of cardiac sarcoidosis to be made.

Neurochorioretinitis due to the course of ocular sarcoidosis is relatively rare case. It usually responds well to conventional treatment with corticosteroids. We want to present the patient effectively treated with long acting analogue of somatostatin (Octreotide), who failed to respond to previous corticosteroids treatment.

We are presenting a 76-year-old women with abdominal pain, constipation and lost of weight. On basis of performed tests we diagnosed sarcoidosis of peripheral and retroperitoneal lymph nodes.

46-years old woman was diagnosed in Department of Infectious Diseases of Medical Academy in Wrocław due to dyspeptic disorder, eosinophilia and high AspAT, AlAT, AP and GGTP level in blood serum. Liver biopsy was performed. Hepatic, noncaseating granulomata were found in liver biopsy specimen. Histological changes indicate to liver sarcoidosis.

Authors present 3 cases of pulmonary sarcoidosis coexisting with disturbances in ecg. Cardiac scintigraphy showed segmental disorders of perfusion in those patients. We believe that morphological diagnosis of sarcoidosis and coexistent disturbances in ecg are indications to perform cardiac perfusion scintigraphy. Changes in cardiac perfusion can also suggest the presence of sarcoid granulomas in the heart muscle.

The authors present ocular changes observed in sarcoidosis. The most frequent features are: symptoms of dry eye and uveitis. Frequency of ocular manifestations leads to the conclusion that ophthalmic examinations ought to be routine procedure at sarcoid patients.

Two cases of lungs and mediastinal lymph nodes sarcoidosis with involvement of central and peripheral nervous system were described. In one patient the vascular type of neurosarcoidosis was diagnosed, in another-the inflammatory type, with pyramidal and cerebellar symptoms and severe peripheral changes. Both cases were illustrated with MRI scans.

A rare case of sarcoidosis with massive pleural and pericardial effusion in 30-year-old female patient was presented. Diagnosis was established on the basis of the specimen examination of bronchial mucosa and lymph nodes. Suspicion of heart sarcoidosis was supported by radioisotopic examination. Following steroid therapy, fast disappearance of the pathological changes was observed.

We described a young male with severe Guillain-Barré syndrome in whom pulmonary sarcoidosis was also detected. Based upon the results of diagnostic procedures (nerve biopsy, CSF examination, electrophysiological study) we postulate that this was a Guillain-Barré syndrome coexisting with sarcoidosis, and not the case of sarcoid neuropathy.

The occurrence of lymphoid malignancy tissue, most often Hodgkin or non-Hodgkin lymphoma, after several years of the diagnosis of sarcoidosis has been named sarcoidosis-lymphoma syndrome. The pathogenesis of this syndrome is probably connected with dysregulation of T lymphocytes. A woman with acromegaly with non-Hodgkin lymphoma diagnosed six years after sarcoidosis is presented in this paper. The CVP chemotherapy helped to establish 9-years, lasting remission still.

Sarcoidosis is a multisystemic disease of unknown etiology with characteristic picture of immunological disorders. As an unfavourable course of the disease both fibrosis and abnormal calcium metabolism may occur. The last one is reflected by hypercalcemia and/or hypercalcuria. In this paper the recent advances in the explanation of pathogenesis of impaired calcium homeostasis in patients with sarcoidosis have been reviewed. The evaluation of calcium concentration in urine and plasma, production rate of vitamin D metabolites, isolation and structural identification of 1,25 dihydroxy vitamin D3 as well as regulation of its synthesis by pulmonary alveolar macrophages from patients with sarcoidosis have been discussed. Subsequently, vitamin D metabolism by sarcoid lymph node and application of steroids and chloroquine for the treatment of disturbed calcium metabolism has been presented.

Two cases of sarcoidosis with peripheral lymphatic nodes involvement and coexisting toxoplasmosis are presented. Both cases illustrate diagnostic and differentiating problems in patients with chronic lymphatic nodes enlargement and positive serological reaction to T. gondii antigen. An emphasis is on the importance of the histological examination of the lymphatic nodes for the sarcoidosis diagnosis and contribution of T. gondii to the disease. Positive serological reaction to T. gondii antigen in patients with sarcoidosis may reflect inactive toxoplasmosis; however, periodical serological tests are necessary monitoring the due immunosuppressive treatment used in patients with sarcoidosis.

The authors present the incidence of bronchial obstruction in patients with pulmonary sarcoidosis basing on their own material from the years 1960-1988. Bronchial obstruction was diagnosed when the Tiffeneau index was lower than 70%. In the analyzed group 93 (5.7%) patients were found to meet the criterion for bronchial obstruction. Out of this group two forms were selected those with the pure bronchial obstruction and mixed, i.e. with coexistent restrictive changes. The author discuss the possible mechanism of developing bronchial obstruction in sarcoidosis.

A case report of a 45 year old female with a high suspicion of a lung tumor based on radiological and bronchoscopic findings is presented. Typical sarcoid changes were seen in biopsies from bronchial mucosa. Steroid therapy was instituted but due to intolerance had to be terminated. The patient was treated with chlorambucil, cyclophosphamide and azathioprine. Therapy was monitored with bronchoscopy. The best response was seen after steroid therapy, less to chlorambucil and cyclophosphamide. Azathioprine was least effective.

A case of hydrocephalus is described which developed as a late complication of sarcoidosis. In a female patient aged 37 years manifestations of sarcoidosis in the form of Löfgren's syndrome developed 13 years earlier and the diagnosis was confirmed with histological examination of lymph node and bronchial mucosa. After corticoid treatment all manifestations disappeared. In 1975 symptoms of increasing hydrocephalus appeared with violent headaches, visual and hearing disturbances, transient disturbances of consciousness, nausea, vomiting and transient loss of vision with gradually decreasing visual acuity. On the fundus papilloedema was present and angiography and pneumoencephalography demonstrated significant hydrocephalus without shifting of cerebral structures, and without pathological circulation. Surgical treatment (ventriculoatrial shunt) and following corticoid therapy permitted to abolish all symptoms and obtain normalization of eye and improvement of visual acuity.