Zaher Wael, Place Sammy, Gombeir Yannick
Department of Internal Medicine, EpiCURA Hospital, Hornu, Belgium.
Eur J Case Rep Intern Med. 2020 May 11;7(8):001621. doi: 10.12890/2020_001621. eCollection 2020.
arcoidosis is a multisystemic disease producing non-caseating granulomas. The aetiology and pathogenesis are unknown. We herewith report an atypical case of cutaneous sarcoidosis.
A 50-year-old female presented with an onset of multiple subcutaneous nodules on her 4 limbs. These nodules appeared concomitantly with the initiation of radioactive iodine therapy for papillary thyroid cancer. These nodules were not obvious on inspection of the skin, but easily felt on palpation.The biopsy of the subcutaneous nodules revealed hypodermic non-caseating granulomas consistent with sarcoidosis. The patient underwent an 18F-fluorodeoxyglucose positron emission tomography (PET) scan study that revealed, besides the subcutaneous nodules, multiple hypermetabolic mediastinal lymphadenopathies and cervical adenopathies. Biopsy of the mediastinal lymphadenopathy showed neither granulomas nor neoplastic cells. Cervical biopsy revealed neoplastic cells of thyroid origin. Laboratory tests were normal. Bronchoalveolar lavage showed a normal CD4/CD8 T-cell ratio.A diagnosis of cutaneous sarcoidosis was established, as well as a recurrence of the cancerous disease. The subcutaneous nodules regressed spontaneously in the absence of any treatment.
arcoidosis is a multisystemic disease of unknown origin. This case illustrates an uncommon occurrence of sarcoidosis, triggered by radioactive iodine therapy. Radioiodine may lead to immunological changes, especially affecting the Th1/Th2 ratio, which may promote the emergence of sarcoidosis in genetically predisposed patients. There is still much to discover to fully understand the pathogenesis of sarcoidosis.
The immunopathogenesis of sarcoidosis is poorly understood, as well as the environmental factors involved.Radioactive iodine therapy for thyroid cancer treatment may be an environmental trigger.The immunological changes induced by radioiodine, especially with respect to the Th1/Th2 ratio, may promote occurrence of sarcoidosis in genetically predisposed patients.
结节病是一种产生非干酪样肉芽肿的多系统疾病。其病因和发病机制尚不清楚。我们在此报告一例皮肤结节病的非典型病例。
一名50岁女性四肢出现多个皮下结节。这些结节在开始针对乳头状甲状腺癌的放射性碘治疗时同时出现。这些结节在皮肤检查时不明显，但触诊时很容易摸到。皮下结节活检显示皮下非干酪样肉芽肿，符合结节病。患者接受了18F-氟脱氧葡萄糖正电子发射断层扫描（PET）研究，结果显示，除皮下结节外，还有多个代谢活跃的纵隔淋巴结肿大和颈部淋巴结肿大。纵隔淋巴结活检未发现肉芽肿和肿瘤细胞。颈部活检发现甲状腺来源的肿瘤细胞。实验室检查正常。支气管肺泡灌洗显示CD4/CD8 T细胞比值正常。诊断为皮肤结节病，同时癌症复发。皮下结节在未进行任何治疗的情况下自行消退。
结节病是一种病因不明的多系统疾病。该病例说明了放射性碘治疗引发的结节病罕见情况。放射性碘可能导致免疫变化，尤其影响Th1/Th2比值，这可能促使遗传易感患者出现结节病。要充分理解结节病的发病机制，仍有许多有待发现之处。
结节病的免疫发病机制以及相关环境因素尚不清楚。甲状腺癌治疗的放射性碘治疗可能是一个环境触发因素。放射性碘诱导的免疫变化，尤其是关于Th1/Th2比值，可能促使遗传易感患者发生结节病。
