结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Epidemiology and Estimated Population Burden of Selected Autoimmune Diseases in the United States

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.22906

Primary Biliary Cirrhosis

• Neurosarcoidosls is a disorder that is difficult to diagnose and manage. We assessed its neurological manifestations in 649 patients seen at The Johns Hopkins Hospital, Baltimore, from 1975 through 1980. Neurological problems could be attributed to neurosarcoidosis in 33 patients (5.1%). The presenting manifestation of sarcoidosis was neurological in 16 (48%) of them. Cranial neuropathy was the most frequent problem, and a peripheral facial nerve palsy was the single most common abnormality. Other manifestations were aseptic meningitis, hydrocephalus, parenchymatous disease of the central nervous system, peripheral neuropathy, and myopathy. Three-quarters of the patients were treated with steroids. The outcome was good in 27 (82%) of 33 episodes of neurological dysfunction in 25 patients with a well-documented clinical course. A thorough investigation of patients with suspected neurosarcoidosis is recommended to establish the diagnosis, delineate the extent of disease, and guide therapy.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=neur&articleId=584545&pdfFileName=archneur_42_9_022.pdf

Sarcoidosis and its neurological manifestations.

Epidemiology of primary sclerosing cholangitis and primary biliary cirrhosis: A systematic review

Epidemiology of primary biliary cirrhosis in a defined rural population in the northern part of Sweden

In 22 patients with sarcoidosis, symptoms and signs of muscle involvement were scanty, but muscle biopsy showed epithelioid cell granulomas consistent with sarcoidosis in 11 patients (50%). Serial sectioning of the muscle biopsies increased the diagnostic yield. The incidence of muscle involvement was highest among patients with both acute sarcoidosis and erythema nodosum. Involvement of other organs was common in patients with muscle sarcoidosis. In two patients with negative scalene node biopsy and negative bronchial and transbronchial biopsies, muscle biopsy showed histological evidence of sarcoidosis. Muscle involvement is common in patients with sarcoidosis, but in many cases there are few or no symptoms. In patients with both acute sarcoidosis and erythema nodosum, muscle biopsy frequently provides histological evidence of the disease. Good cooperation with the pathologist and serial sectioning of the biopsies are necessary if muscle biopsy is to be used as a routine in the diagnosis of sarcoidosis.

Muscle Involvement in Sarcoidosis

Twenty-five patients with primary biliary cirrhosis (PBC) in different stages were investigated with respect to pulmonary function abnormalities. The results were compared with a reference sample of 17 sex- and age-matched healthy subjects. A high prevalence of lung function impairment was found in the PBC patients (14/25 [56%]). Bronchial asthma was present in three patients, and severe lung emphysema in one. These four patients had an abnormal lung function, mainly of obstructive type. There was a statistically significant difference between the remaining 21 PBC patients without chronic obstructive lung disease and the reference subjects with respect to diffusion capacity. Almost all abnormal lung function data were found in the symptomatic PBC patients (i.e. symptoms of pruritus, xanthoma, xanthelasmata, jaundice, hyperpigmentation, hepatosplenomegaly), 13 out of 18 (72%), whereas only one out of seven asymptomatic patients was affected. Nine patients (36%) had reduced diffusion capacity compared with none of the reference subjects. The lung function abnormalities in PBC patients are similar to those found in sarcoidosis, another granulomatous disease.

Lung function abnormalities in patients with primary biliary cirrhosis.

Musculo-skeletal symptoms were screened in 24 consecutive patients with newly diagnosed sarcoidosis and followed up two years later. Ten patients had joint involvement. Symptoms were most frequently found in ankle joints, followed by hand and knee joints. Arthritis was found in seven (29%) patients, two of whom suffered from monoarthritis of foot and wrist joint, respectively. Three patients had tenosynovitis. Muscle symptoms such as myalgia were present in six patients. Open biopsy of the gastrocnemius muscle showed epithelioid cell granulomatosis in nine of 20 patients. Only three of these nine patients had symptoms of myalgia, although not in the biopsied muscle. At follow-up, musculo-skeletal symptoms were found in only three patients, all of whom initially had Lofgren's syndrome.

Per Uddenfeldt

Papers

Epidemiology of primary biliary cirrhosis in a defined rural population in the northern part of Sweden

Muscle Involvement in Sarcoidosis

Lung function abnormalities in patients with primary biliary cirrhosis.

Musculo-skeletal Symptoms in Early Sarcoidosis: Twenty-Four Newly Diagnosed Patients and a Two-year Follow-up