Weeraddana Prabasha, Othman Hedaya, Thomas Teena, Walgamage Malsha, Odujoko Oluwole, Gao Wenli
Internal Medicine, Danbury Hospital, Danbury, USA.
Pathology and Laboratory Medicine, Danbury Hospital, Danbury, USA.
Cureus. 2023 Apr 22;15(4):e37973. doi: 10.7759/cureus.37973. eCollection 2023 Apr.
Sarcoidosis is a systemic granulomatous disease characterized by the hyperactivation of CD4 T cells, CD8 T cells, and macrophages. Clinical presentations of sarcoidosis are highly variable. Sarcoidosis is unknown in its etiology, but it suggests it may result from exposure to specific environmental agents in genetically susceptible people. Sarcoidosis commonly involves the lungs and lymphoid system. Bone marrow involvement in sarcoidosis is uncommon. Sarcoidosis rarely results in intracerebral hemorrhage due to severe thrombocytopenia secondary to bone marrow involvement. We present the case of a 72-year-old woman who has been in remission from sarcoidosis for 15 years and developed intracerebral hemorrhage secondary to severe thrombocytopenia due to sarcoidosis recurrence in the bone marrow. The patient presented to the emergency department with a generalized, non-blanching petechiae rash and nose and gum bleeding. Her labs showed a platelet count of less than 10.000/mcL, and computed tomography (CT) showed intracerebral hemorrhage. A bone marrow biopsy revealed a small, non-caseating granuloma indicative of a sarcoidosis relapse in the bone marrow.
结节病是一种全身性肉芽肿性疾病，其特征为CD4 T细胞、CD8 T细胞和巨噬细胞的过度活化。结节病的临床表现高度多变。结节病的病因尚不清楚，但提示可能是在基因易感人群中接触特定环境因素所致。结节病通常累及肺部和淋巴系统。结节病累及骨髓并不常见。由于骨髓受累继发严重血小板减少，结节病很少导致脑出血。我们报告一例72岁女性病例，该患者结节病已缓解15年，因骨髓结节病复发继发严重血小板减少而发生脑出血。患者因全身性非压之褪色的瘀点皮疹以及鼻出血和牙龈出血就诊于急诊科。她的实验室检查显示血小板计数低于10,000/微升，计算机断层扫描（CT）显示脑出血。骨髓活检显示一个小的非干酪样肉芽肿，提示骨髓结节病复发。
