Guest guest Posted November 1, 2009 Report Share Posted November 1, 2009 Enlarged liver and spleen is a common area that sarcoidosis loves. If you aren't on Milk Thistle, get on it. It is the best liver detoxifier and won't interact with any of the meds. I was turned on to it by my massage therapist, who had had Hodgkins back in the 60's-- when she was 9 or 10. She was one of the first kids to ever get radiation-- and they burnt the crap out of her internal organs. She ended up with having to have the pericardial sac removed from around her heart, so that the heart could beat correctly. Her docs at Stanford put her on MT so that the meds she was on didn't wipe out her liver. She ended up with systemic cancer and on autopsy, her liver was the only organ that wasn't effected. I've been using it for several years now, and even on the meds I'm on-- my liver enzymes are in good shape. Here is just one article on Liver sarc. Letter to the Editor Dear Editor, Sarcoidosis is a systemic granulomatous disease of unknown aetiology. It emerges in the form of hiler adenopathy and interstitial pulmonary disease in most cases. The lungs, eyes, skin, abdominal organs, central nerve system and bones are among the organs involved.1,2 Although non-caseous granulomas are detected histopathologically in the involvement of the liver in sarcoidosis, the values obtained from liver function test are generally normal. Hepatomegaly and retroperitoneal adenopathy are most frequently seen even though radiological evidence in sarcoidosis-related granulomatous hepatitis is rare.2,3 Sarcoidosis may also be related to endocrine autoimmune diseases. Autoimmune thyroiditis accompanying sarcoidosis has been reported in the literature; however, the combination of sarcoidosis with other autoimmune diseases is not frequent.4,5 Autoimmune diseases such as type 1 diabetes mellitus (DM) and Hashimoto’s thyroiditis, elevation of the liver function test values and granulomatous hepatitis with hepatomegaly were observed to accompany sarcoidosis in our case. To our knowledge, no other sample cases with all these components have been reported in the literature. A 50-year-old female patient complaining of backache and fatigue was admitted to our clinic due to elevation of liver function test values. The patient had undergone total abdominal hysterectomy and bilateral salpingooophorectomy 6 years prior to this presentation. She was diagnosed with type 1 diabetes mellitus 25 years ago and has had Hashimoto’s thyroiditis, osteoporosis and fibromyalgia for 3 years. A high-resolution computed tomographic (CT) scan, obtained in February 2004 due to dyspnoea, revealed a ground-glass appearance in the lungs. Open lung biopsy was performed and the diagnosis of sarcoidosis was made. One-year methlyprednisolone therapy was started. She weighed 74 kg and her height was 1.7 m. Her blood pressure was 100/80 mmHg. The thyroid gland palpated heterogeneously. Incision scars of approximately 10 cm extending from the left anterior axillary line to the posterior axillary line and a median infra-umbilical incision of approximately 15 cm were noted. The liver was palpable approximately 5 cm below the costal margin. There were numerous subdermal nodules, and the biggest of which was 1 x 1 cm in the right upper and lower extremities. Laboratory investigations revealed the following – fasting glucose level: 228 mg/dL, total cholesterol: 279 mg/dL, Sarcoidosis with Granulomatous Hepatitis and Autoimmune Endocrine Involvement triglyceride: 299 mg/dL, ALT: 37 U/L (2-40), AST: 32 U/ L (2-40), ALP: 857 U/L (65-300), GGT: 232 U/L (2-50), LDH: 342 U/L (220-450), total bilirubin: 0.4 mg/dL, direct bilirubin: 0.1 mg/dL, free T3: 2.8 pg/mL (1.57-4.71), free T4: 1.5 ng/dL (0.85-1.78), TSH: 1.41 uIU/mL, anti-TG >3000 IU/mL and anti-TPO >1000 IU/mL. The complete blood count, chest x-ray and electrocardiography were within normal limits. The patient was taking 11 units (U) insulin aspart (NovoRapid®) every morning and every afternoon, 12 U every evening and 25 U detemir (Levemir®) every night for DM and thyroxine (Levotiron®) tb 1 x 0.15 mg, etodolac (Etol Fort®) 400 mg 2 x 1, strontium ranelate (Protelos®) 2 g every day for the other diagnoses. As results of the liver function tests were elevated, the treatment of strontium ranelate (Protelos®) and etodolac (Etol Fort®) were discontinued. The hypoechoic areas and heterogenous parenchymal echo, the border of which could not be clearly distinguished in the thyroid tissues in a form to be congruent with the thyroiditis, were monitored on the thyroid ultrasonography of the patient whose thyroid auto-antibodies were positive. The thyroid biopsy of the patient performed 3 years ago was reported with a diagnosis of Hashimoto’s thyroiditis. In the examination of the rise in ALP and GGT values, the viral hepatitis markers Anti-HBs, Anti-HBe and Anti-HBcIgG were positive, whereas the others were negative. Of the autoimmune hepatitis markers, ANA, AMA, LKM-1, Anti ds DNA and SMA antibodies were negative. 5’ nucleotidase (19.40 U/L, N: 0-9) and ALP L2 liver isoenzyme (% 18, N: % 1-14) values were detected as high. The craniocaudal dimension of the liver measured 19 cm. A 15-cm hyperechoic solid mass lesion, congruent with haemangioma, was detected in the lateral segment of left lobe of the liver on abdominal ultrasonography. Liver biopsy was performed with the present findings. Granulomatous hepatitis was suspected. The biopsy revealed that granulomatous hepatitis was accompanied by light degree lobular activity without duct damage. There are numerous pathologies that may cause granulomatous hepatitis. Hepatitis B, alcohol or chronic liver disease due to haemochromatosis, sarcoidosis, tuberculosis, neoplasms, agents of infection and medicines are among these pathologies.6 et al7 established sarcoidosis in 12% of patients with hepatic granuloma. Non-caseous granulomas may cause biochemical variations in the cholestatic pattern by locating at the periportal area in the granulomatous hepatitis due to sarcoidosis.8 Likewise, the elevation of the ALP and GGT levels, suggesting cholestatic pathology with non-caseous 978 ls Academy of Medicine Granulomatous Hepatitis—Ismail Hakki Kalkan et al Ismail Hakki Kalkan,1MD, Ilkay Koca Kalkan,2MD, Dilek Tüzün,1MD, Murat Suher,1MD 1 Internal Medicine Department, Ankara Ataturk Education and Research Hospital, Turkey 2 Pulmonology Department, Ankara Ataturk Chest Disease and Surgery Education and Research Hospital, Turkey Address for Correspondence: Dr Ismail Hakki Kalkan, 65 Sokak 19/8, Emek 06510, Ankara, Turkey. Email: drismailster@... granulomas, was also established in our case. Clinical features are usually not distinct in cases of granulomatous hepatitis due to sarcoidosis. While the elevation of the liver function test values are established in 40% of the cases, it presented in only 20% of cases of hepatomegalia.9 Likewise, an elevation of the liver function test values together with hepatomegalia was detected on abdominal ultrasonography. Granulomas may be lost spontaneously, but they may also cause progressive fibrosis. Fibrosis was detected in 21% of the biopsies in a recent study.10 Portal hypertension or cirrhosis which shows the involvement of only the liver and not the lung or any other organs may develop due to fibrosis. This may result in sarcoidosis and can be dangerous and life-threatening Only patients with non-caseous granulomas in the liver involvement due to sarcoidosis are recommended to take up follow-up sessions, as in our case. Improvement in clinical picture and biochemical values established by glucocorticoid therapy were found only in a few patients with sclerosant cholangitis and primary biliary cirrhosis.1 There are immunoglobulins developing against numerous antigens, including the self-antigens in the circulation, together with the local cellular immune response in patients with pulmonary sarcoidosis. This also suggests that sarcoidosis may accompany autoimmune diseases.11,12 It has been shown that it is difficult for immunoglobulins to inhibit TPO activity, and to bind to their own antigens in the healthy tissue. However, it has also been thought that TPO and TG antibodies may cause inflammation by binding to their own antigens in the target tissue on the condition of impairment of the thyroid tissue due to sarcoidosis. Consequently, the patients with positive anti-TPO and anti-TG at low titration have been supported to have a longterm follow-up due to the development of Hashimoto’s thyroiditis.13 Papadopoulos et al4 detected autoimmune thyroiditis in 13 (16.7%) and type 1 DM in 2 (2.6%) of 78 cases with sarcoidosis. The frequency of autoimmune thyroiditis was found to be significantly high when compared with the control group; however, no difference could be acquired when type 1 DM was compared with the control group. In another study, autoimmune thyroiditis was reported in only 2 (3.1%) of 64 Japanese cases.12 Nakamura et al14 reported both positive anti-TPO and anti-TG in 17 (27.4%) of 62 cases with pulmonary sarcoidosis. Hashimoto’s thyroiditis was established in only 7 (11.3%) of the cases. Besides that, the positivity of anti-TPO and anti-TG was established in cases over 40 years old. Conclusion Sarcoidosis is likely to be as a result of an interplay of environmental and genetic factors as well as an external agent triggering a characteristic immune response in genetically susceptible individuals. Despite a recent large multicentre study, A Case-Control Etiologic Study of Sarcoidosis (ACCESS), no single causative environmental agent has been identified. It affects mostly young people, targeting primarily the lung and hilar lymph nodes. In some cases, the liver is also involved. Although the clinical features of the granulomatous hepatitis are making good progresses, it should keep in mind that in the treatment of patients with sarcoidosis, fibrosis, portal hypertension and cirrhosis may develop over time.15 Besides that, it should not be forgotten that endocrine organs may be damaged because of the systemic involvement of sarcoidosis due to autoimmune causes. Healthcare providers should be aware of the diverse range of multi-systemic presentations. Our case is unique as there has been no article on such a combination of involvement in the literature. REFERENCES 1. Blich M, Yeouda E. Clinical manifestations of sarcoid liver disease. J Gastroenterol Hepatol 2004;19:732-7. 2. Farman J, G, Brunetti J, Tuvia J, Ng C, Rotterham H. Abdominal manifestations of sarcoidosis, CT appearances. Clin Imaging 1995;19:30-3. 3. Maddrey WC, s CJ, Boitnott JK, Iber FL Sarcoidosis and chronic hepatic disease: a clinical and pathologic study of 20 patients. Medicine (Baltimore) 1970;49:375-95. 4. Papadopoulos KI, Hörnblad Y, Lilijebladh H, Hallengren B. High frequency of endocrine autoimmunity in patients with sarcoidosis. Eur J Endocrinol 1996;134: 331-6. 5. Hancock BW, Millard LG. Sarcoidosis and thyrotoxicosis: a study of five patients. Br J Dis Chest 1976;70:129-33. 6. Cable GG. Granulomatous hepatitis due to sarcoidosis: a case report. Aviat Space Environ Med 2001;72:1141-4. 7. CS, Nicholls J, Rowland R, LaBrooy JT. Hepatic granulomas: a 15-year experience in the Royal Adelaide Hospital. Med J Aust 1988;148:71-4. 8. Ishak KG. Sarcoidosis of the liver and bile ducts. Mayo Clin Proc 1988;73:467-72. 9. Takada K, Ina Y, Noda M, Sato T, Yamamoto M, Morishita M. The clinical course and prognosis of patients with severe, moderate or mild sarcoidosis. J Clin Epidemiol 1993;46:359-66. 10. Devaney K, Goodman ZD, Epstein MS, Zimmerman HJ, Ishak KG. Hepatic sarcoidosis. Clinicopathologic features in 100 patients. Am J Surg Pathol 1993;17:1272-80. 11. Hunninghake GW, Crystal RG. Mechanisms of hypergammaglobulinemia in pulmonary sarcoidosis. Site of increased antibody production and role of T lymphocytes. J Clin Invest 1981;67:86-92. 12. Wiesenhutter CW, Sharma OP. Is sarcoidosis an autoimmune disorder?: Report of four cases and review of literature. Semin Arthritis Rheum 1979;9:124-44. 13. Chida K, Sato A, Yasuda L, Shichi I, Iwata M, Gemma H, et al. Clinical aspects of sarcoidosis with autoantibodies. Nihon Kyoshu Shikka Gakkai Zasshi 1989;27: 194-9 14. Nakamura H, Genma R, Mikami T, Kitahara A, Natsume H, Andoh S, et al. High incidence of positive autoantibodies against thyroid peroxidase and thyroglobulin in patients with sarcoidosis. Clinl Endocrinol (Oxf) 1997;46:467-72. 15. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H Jr, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001;164:1885-9. Here is a second article complete with MRI's etc. http://jasn.asnjournals.org/cgi/reprint/12/3/616.pdf Hope this helps, Tracie NS Co-owner/moderator To: Neurosarcoidosis Sent: Sun, November 1, 2009 5:56:50 AMSubject: Re: File - Religious, Political and Other Topics Dear Group, I can't believe it's been just about a week since I found you. I can't believe how much love and support I've received in that little time. It will be 3 years in March since i was diagnosed but have had symptoms for close to ten years (just didn't know what I had). I thank you all for inviting me in and being there. I have another question, the joint pains just started getting bad a few months ago and now it's to the point some days are bearable and other aren't but a new thing just started and I want to know if it's the disease. I guess I've had it for some time but it was so small I didn't give notice,. But the last day or two have been bad. If I bend to my side. like over a couch to pick up a napkin (while sitting on it) I get a sever pain depending on which side I bend. if I bend to my right it's like I get a sharp pain in my liver and to my left it's almost as if I can feel my spleen and it hurts and then lingers. These things are not normal. If I didn't mention it in my first letter to you all, I've been a Chiropractor for 21 years, I used to work 6 days a week now I'm down to 2 in pain. I know what's normal pain and what's not normal, this is not normal. I just want to know if it's Sarcoid related,.It didn't take me long to realize you people know much more then my Pulmonologist- he thinks this is a painless disease unless it affects the skin, Your in Health Mitch Ps Yes, feel free to ask me any musculoskelatal questions, we are all here to help each other, right? File - Religious, Political and Other Topics Dear All,This is primarily a support group for a NASTY illness that does require people to call on their beliefs to get them through the dark days. Faith is certainly an issue when you are dealing with chronic and/or a progressive illness. Beyond these screens are real people with real feelings. People who laugh, cry, need, and are needed. We all have one thing in common and that is this illness which takes too much away from us like our entire life. When this list was started, it was started with the thought in mind that this disease robs us of way too much, and I was NOT going to add to that by having rules and regulations. We have enough limitations in REAL life, let alone bringing them into a support group. We also did not even imagine a list of more than 500 members who are so closely knitted as one tight loving family, which I personally think is the best bit of this list. This letter serves only as a guide from discussions with fellow moderators and from my observations. We have developed a Chatroom that is open 24/7. You are welcome to post an email to the group stating that you are in the chatroom-- come over and join in. This Chatroom has a Faith Chatroom and you are more than welcome to share how your Higher Power gets you through dealing with this disease. This has come about from suggestions as how to how to deal with posts with religious threads, and really lets face it there are going to be topics on this list you are not going to be interested in and perhaps religion is one of them. In this instance, the best way to deal with the topics you don't like is to press the delete key. People can get very precious of their beliefs. Fair enough, it is personal. However my way is uniquely mine. Your way is uniquely yours. We respect your path, and we expect you to respect ours. We practice tolerance.Our motto is tolerance, empathy and compassion. We want the group site to be a place of education and sharing of the newest research and treatment options, so that those who need direction and understanding in the physical and emotional components of living with chronic illness can be explained and put into simple language so that you understand what is going on with your body. We are a global community with people from Australia, Europe, Africa, America and indeed all the continents. Therefore we support the right for everyone to have his or her own beliefs, which may or may not differ from your own. If there is a discussion thread you dislike, delete it. If there is a religious or political comment that is different from your own view, delete it. We are bonded by illness yet are all individuals. The message that needs to be shared is the fact that united as a family we stand: be that shown by praying for each other, meditating for each other, loving one another, holding in our thoughts or hearts, or one of a thousand ways other ways to express that we support each other in this battle. It is possible to send prayers to someone without trying to convert them to your own special religion. When you send "prayers", you are actually sending special thoughts and well wishes -- and this is the way it should be taken. This is the way it should be handled. Any private letters you send or receive from members of this list we hope are courteous and polite. Obviously this is an area we have no control over and really, why should we? We maintain a support group, not monitor everyone's lives! My point is - be yourself, share your stories, offer your prayers, your love, your support, and know you are supported whether you are Catholic or Wiccan or Atheist. And if you don't like the post, be it religious or not - PRESS DELETE! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2009 Report Share Posted November 1, 2009 I used to get a lot of liver pain and swear by milk thisle. If I don't take it the pain starts up again. Life is short...live it to the fullest...to your last living breath. Subject: Re: spleen and liver painTo: Neurosarcoidosis Date: Sunday, November 1, 2009, 10:14 PM Enlarged liver and spleen is a common area that sarcoidosis loves. If you aren't on Milk Thistle, get on it. It is the best liver detoxifier and won't interact with any of the meds. I was turned on to it by my massage therapist, who had had Hodgkins back in the 60's-- when she was 9 or 10. She was one of the first kids to ever get radiation-- and they burnt the crap out of her internal organs. She ended up with having to have the pericardial sac removed from around her heart, so that the heart could beat correctly. Her docs at Stanford put her on MT so that the meds she was on didn't wipe out her liver. She ended up with systemic cancer and on autopsy, her liver was the only organ that wasn't effected. I've been using it for several years now, and even on the meds I'm on-- my liver enzymes are in good shape. Here is just one article on Liver sarc. Letter to the Editor Dear Editor, Sarcoidosis is a systemic granulomatous disease of unknown aetiology. It emerges in the form of hiler adenopathy and interstitial pulmonary disease in most cases. The lungs, eyes, skin, abdominal organs, central nerve system and bones are among the organs involved.1,2 Although non-caseous granulomas are detected histopathologically in the involvement of the liver in sarcoidosis, the values obtained from liver function test are generally normal. Hepatomegaly and retroperitoneal adenopathy are most frequently seen even though radiological evidence in sarcoidosis-related granulomatous hepatitis is rare.2,3 Sarcoidosis may also be related to endocrine autoimmune diseases. Autoimmune thyroiditis accompanying sarcoidosis has been reported in the literature; however, the combination of sarcoidosis with other autoimmune diseases is not frequent.4,5 Autoimmune diseases such as type 1 diabetes mellitus (DM) and Hashimoto’s thyroiditis, elevation of the liver function test values and granulomatous hepatitis with hepatomegaly were observed to accompany sarcoidosis in our case. To our knowledge, no other sample cases with all these components have been reported in the literature. A 50-year-old female patient complaining of backache and fatigue was admitted to our clinic due to elevation of liver function test values. The patient had undergone total abdominal hysterectomy and bilateral salpingooophorectomy 6 years prior to this presentation. She was diagnosed with type 1 diabetes mellitus 25 years ago and has had Hashimoto’s thyroiditis, osteoporosis and fibromyalgia for 3 years. A high-resolution computed tomographic (CT) scan, obtained in February 2004 due to dyspnoea, revealed a ground-glass appearance in the lungs. Open lung biopsy was performed and the diagnosis of sarcoidosis was made. One-year methlyprednisolone therapy was started. She weighed 74 kg and her height was 1.7 m. Her blood pressure was 100/80 mmHg. The thyroid gland palpated heterogeneously. Incision scars of approximately 10 cm extending from the left anterior axillary line to the posterior axillary line and a median infra-umbilical incision of approximately 15 cm were noted. The liver was palpable approximately 5 cm below the costal margin. There were numerous subdermal nodules, and the biggest of which was 1 x 1 cm in the right upper and lower extremities. Laboratory investigations revealed the following – fasting glucose level: 228 mg/dL, total cholesterol: 279 mg/dL, Sarcoidosis with Granulomatous Hepatitis and Autoimmune Endocrine Involvement triglyceride: 299 mg/dL, ALT: 37 U/L (2-40), AST: 32 U/ L (2-40), ALP: 857 U/L (65-300), GGT: 232 U/L (2-50), LDH: 342 U/L (220-450), total bilirubin: 0.4 mg/dL, direct bilirubin: 0.1 mg/dL, free T3: 2.8 pg/mL (1.57-4.71), free T4: 1.5 ng/dL (0.85-1.78), TSH: 1.41 uIU/mL, anti-TG >3000 IU/mL and anti-TPO >1000 IU/mL. The complete blood count, chest x-ray and electrocardiography were within normal limits. The patient was taking 11 units (U) insulin aspart (NovoRapid®) every morning and every afternoon, 12 U every evening and 25 U detemir (Levemir®) every night for DM and thyroxine (Levotiron®) tb 1 x 0.15 mg, etodolac (Etol Fort®) 400 mg 2 x 1, strontium ranelate (Protelos®) 2 g every day for the other diagnoses. As results of the liver function tests were elevated, the treatment of strontium ranelate (Protelos®) and etodolac (Etol Fort®) were discontinued. The hypoechoic areas and heterogenous parenchymal echo, the border of which could not be clearly distinguished in the thyroid tissues in a form to be congruent with the thyroiditis, were monitored on the thyroid ultrasonography of the patient whose thyroid auto-antibodies were positive. The thyroid biopsy of the patient performed 3 years ago was reported with a diagnosis of Hashimoto’s thyroiditis. In the examination of the rise in ALP and GGT values, the viral hepatitis markers Anti-HBs, Anti-HBe and Anti-HBcIgG were positive, whereas the others were negative. Of the autoimmune hepatitis markers, ANA, AMA, LKM-1, Anti ds DNA and SMA antibodies were negative. 5’ nucleotidase (19.40 U/L, N: 0-9) and ALP L2 liver isoenzyme (% 18, N: % 1-14) values were detected as high. The craniocaudal dimension of the liver measured 19 cm. A 15-cm hyperechoic solid mass lesion, congruent with haemangioma, was detected in the lateral segment of left lobe of the liver on abdominal ultrasonography. Liver biopsy was performed with the present findings. Granulomatous hepatitis was suspected. The biopsy revealed that granulomatous hepatitis was accompanied by light degree lobular activity without duct damage. There are numerous pathologies that may cause granulomatous hepatitis. Hepatitis B, alcohol or chronic liver disease due to haemochromatosis, sarcoidosis, tuberculosis, neoplasms, agents of infection and medicines are among these pathologies.6 et al7 established sarcoidosis in 12% of patients with hepatic granuloma. Non-caseous granulomas may cause biochemical variations in the cholestatic pattern by locating at the periportal area in the granulomatous hepatitis due to sarcoidosis.8 Likewise, the elevation of the ALP and GGT levels, suggesting cholestatic pathology with non-caseous 978 ls Academy of Medicine Granulomatous Hepatitis—Ismail Hakki Kalkan et al Ismail Hakki Kalkan,1MD, Ilkay Koca Kalkan,2MD, Dilek Tüzün,1MD, Murat Suher,1MD 1 Internal Medicine Department, Ankara Ataturk Education and Research Hospital, Turkey 2 Pulmonology Department, Ankara Ataturk Chest Disease and Surgery Education and Research Hospital, Turkey Address for Correspondence: Dr Ismail Hakki Kalkan, 65 Sokak 19/8, Emek 06510, Ankara, Turkey. Email: drismailster@... granulomas, was also established in our case. Clinical features are usually not distinct in cases of granulomatous hepatitis due to sarcoidosis. While the elevation of the liver function test values are established in 40% of the cases, it presented in only 20% of cases of hepatomegalia.9 Likewise, an elevation of the liver function test values together with hepatomegalia was detected on abdominal ultrasonography. Granulomas may be lost spontaneously, but they may also cause progressive fibrosis. Fibrosis was detected in 21% of the biopsies in a recent study.10 Portal hypertension or cirrhosis which shows the involvement of only the liver and not the lung or any other organs may develop due to fibrosis. This may result in sarcoidosis and can be dangerous and life-threatening Only patients with non-caseous granulomas in the liver involvement due to sarcoidosis are recommended to take up follow-up sessions, as in our case. Improvement in clinical picture and biochemical values established by glucocorticoid therapy were found only in a few patients with sclerosant cholangitis and primary biliary cirrhosis.1 There are immunoglobulins developing against numerous antigens, including the self-antigens in the circulation, together with the local cellular immune response in patients with pulmonary sarcoidosis. This also suggests that sarcoidosis may accompany autoimmune diseases.11,12 It has been shown that it is difficult for immunoglobulins to inhibit TPO activity, and to bind to their own antigens in the healthy tissue. However, it has also been thought that TPO and TG antibodies may cause inflammation by binding to their own antigens in the target tissue on the condition of impairment of the thyroid tissue due to sarcoidosis. Consequently, the patients with positive anti-TPO and anti-TG at low titration have been supported to have a longterm follow-up due to the development of Hashimoto’s thyroiditis.13 Papadopoulos et al4 detected autoimmune thyroiditis in 13 (16.7%) and type 1 DM in 2 (2.6%) of 78 cases with sarcoidosis. The frequency of autoimmune thyroiditis was found to be significantly high when compared with the control group; however, no difference could be acquired when type 1 DM was compared with the control group. In another study, autoimmune thyroiditis was reported in only 2 (3.1%) of 64 Japanese cases.12 Nakamura et al14 reported both positive anti-TPO and anti-TG in 17 (27.4%) of 62 cases with pulmonary sarcoidosis. Hashimoto’s thyroiditis was established in only 7 (11.3%) of the cases. Besides that, the positivity of anti-TPO and anti-TG was established in cases over 40 years old. Conclusion Sarcoidosis is likely to be as a result of an interplay of environmental and genetic factors as well as an external agent triggering a characteristic immune response in genetically susceptible individuals. Despite a recent large multicentre study, A Case-Control Etiologic Study of Sarcoidosis (ACCESS), no single causative environmental agent has been identified. It affects mostly young people, targeting primarily the lung and hilar lymph nodes. In some cases, the liver is also involved. Although the clinical features of the granulomatous hepatitis are making good progresses, it should keep in mind that in the treatment of patients with sarcoidosis, fibrosis, portal hypertension and cirrhosis may develop over time.15 Besides that, it should not be forgotten that endocrine organs may be damaged because of the systemic involvement of sarcoidosis due to autoimmune causes. Healthcare providers should be aware of the diverse range of multi-systemic presentations. Our case is unique as there has been no article on such a combination of involvement in the literature. REFERENCES 1. Blich M, Yeouda E. Clinical manifestations of sarcoid liver disease. J Gastroenterol Hepatol 2004;19:732-7. 2. Farman J, G, Brunetti J, Tuvia J, Ng C, Rotterham H. Abdominal manifestations of sarcoidosis, CT appearances. Clin Imaging 1995;19:30-3. 3. Maddrey WC, s CJ, Boitnott JK, Iber FL Sarcoidosis and chronic hepatic disease: a clinical and pathologic study of 20 patients. Medicine (Baltimore) 1970;49:375-95. 4. Papadopoulos KI, Hörnblad Y, Lilijebladh H, Hallengren B. High frequency of endocrine autoimmunity in patients with sarcoidosis. Eur J Endocrinol 1996;134: 331-6. 5. Hancock BW, Millard LG. Sarcoidosis and thyrotoxicosis: a study of five patients. Br J Dis Chest 1976;70:129-33. 6. Cable GG. Granulomatous hepatitis due to sarcoidosis: a case report. Aviat Space Environ Med 2001;72:1141-4. 7. CS, Nicholls J, Rowland R, LaBrooy JT. Hepatic granulomas: a 15-year experience in the Royal Adelaide Hospital. Med J Aust 1988;148:71-4. 8. Ishak KG. Sarcoidosis of the liver and bile ducts. Mayo Clin Proc 1988;73:467-72. 9. Takada K, Ina Y, Noda M, Sato T, Yamamoto M, Morishita M. The clinical course and prognosis of patients with severe, moderate or mild sarcoidosis. J Clin Epidemiol 1993;46:359-66. 10. Devaney K, Goodman ZD, Epstein MS, Zimmerman HJ, Ishak KG. Hepatic sarcoidosis. Clinicopathologic features in 100 patients. Am J Surg Pathol 1993;17:1272-80. 11. Hunninghake GW, Crystal RG. Mechanisms of hypergammaglobulinemia in pulmonary sarcoidosis. Site of increased antibody production and role of T lymphocytes. J Clin Invest 1981;67:86-92. 12. Wiesenhutter CW, Sharma OP. Is sarcoidosis an autoimmune disorder?: Report of four cases and review of literature. Semin Arthritis Rheum 1979;9:124-44. 13. Chida K, Sato A, Yasuda L, Shichi I, Iwata M, Gemma H, et al. Clinical aspects of sarcoidosis with autoantibodies. Nihon Kyoshu Shikka Gakkai Zasshi 1989;27: 194-9 14. Nakamura H, Genma R, Mikami T, Kitahara A, Natsume H, Andoh S, et al. High incidence of positive autoantibodies against thyroid peroxidase and thyroglobulin in patients with sarcoidosis. Clinl Endocrinol (Oxf) 1997;46:467-72. 15. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H Jr, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001;164:1885-9. Here is a second article complete with MRI's etc. http://jasn.asnjournals.org/cgi/reprint/12/3/616.pdf Hope this helps, Tracie NS Co-owner/moderator To: Neurosarcoidosis Sent: Sun, November 1, 2009 5:56:50 AMSubject: Re: File - Religious, Political and Other Topics Dear Group, I can't believe it's been just about a week since I found you. I can't believe how much love and support I've received in that little time. It will be 3 years in March since i was diagnosed but have had symptoms for close to ten years (just didn't know what I had). I thank you all for inviting me in and being there. I have another question, the joint pains just started getting bad a few months ago and now it's to the point some days are bearable and other aren't but a new thing just started and I want to know if it's the disease. I guess I've had it for some time but it was so small I didn't give notice,. But the last day or two have been bad. If I bend to my side. like over a couch to pick up a napkin (while sitting on it) I get a sever pain depending on which side I bend. if I bend to my right it's like I get a sharp pain in my liver and to my left it's almost as if I can feel my spleen and it hurts and then lingers. These things are not normal. If I didn't mention it in my first letter to you all, I've been a Chiropractor for 21 years, I used to work 6 days a week now I'm down to 2 in pain. I know what's normal pain and what's not normal, this is not normal. I just want to know if it's Sarcoid related,.It didn't take me long to realize you people know much more then my Pulmonologist- he thinks this is a painless disease unless it affects the skin, Your in Health Mitch Ps Yes, feel free to ask me any musculoskelatal questions, we are all here to help each other, right? File - Religious, Political and Other Topics Dear All,This is primarily a support group for a NASTY illness that does require people to call on their beliefs to get them through the dark days. Faith is certainly an issue when you are dealing with chronic and/or a progressive illness. Beyond these screens are real people with real feelings. People who laugh, cry, need, and are needed. We all have one thing in common and that is this illness which takes too much away from us like our entire life. When this list was started, it was started with the thought in mind that this disease robs us of way too much, and I was NOT going to add to that by having rules and regulations. We have enough limitations in REAL life, let alone bringing them into a support group. We also did not even imagine a list of more than 500 members who are so closely knitted as one tight loving family, which I personally think is the best bit of this list. This letter serves only as a guide from discussions with fellow moderators and from my observations. We have developed a Chatroom that is open 24/7. You are welcome to post an email to the group stating that you are in the chatroom-- come over and join in. This Chatroom has a Faith Chatroom and you are more than welcome to share how your Higher Power gets you through dealing with this disease. This has come about from suggestions as how to how to deal with posts with religious threads, and really lets face it there are going to be topics on this list you are not going to be interested in and perhaps religion is one of them. In this instance, the best way to deal with the topics you don't like is to press the delete key. People can get very precious of their beliefs. Fair enough, it is personal. However my way is uniquely mine. Your way is uniquely yours. We respect your path, and we expect you to respect ours. We practice tolerance.Our motto is tolerance, empathy and compassion. We want the group site to be a place of education and sharing of the newest research and treatment options, so that those who need direction and understanding in the physical and emotional components of living with chronic illness can be explained and put into simple language so that you understand what is going on with your body. We are a global community with people from Australia, Europe, Africa, America and indeed all the continents. Therefore we support the right for everyone to have his or her own beliefs, which may or may not differ from your own. If there is a discussion thread you dislike, delete it. If there is a religious or political comment that is different from your own view, delete it. We are bonded by illness yet are all individuals. The message that needs to be shared is the fact that united as a family we stand: be that shown by praying for each other, meditating for each other, loving one another, holding in our thoughts or hearts, or one of a thousand ways other ways to express that we support each other in this battle. It is possible to send prayers to someone without trying to convert them to your own special religion. When you send "prayers", you are actually sending special thoughts and well wishes -- and this is the way it should be taken. This is the way it should be handled. Any private letters you send or receive from members of this list we hope are courteous and polite. Obviously this is an area we have no control over and really, why should we? We maintain a support group, not monitor everyone's lives! My point is - be yourself, share your stories, offer your prayers, your love, your support, and know you are supported whether you are Catholic or Wiccan or Atheist. And if you don't like the post, be it religious or not - PRESS DELETE! Quote Link to comment Share on other sites More sharing options...
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