Sarcoidosis with Multiple Organ Involvement-A Case Report

多器官侵犯之類肉瘤症－病例報告

黃德光(De-Kuang Hwang) ； 張由美(Yu-Mei Chung) ； 黃德豐(De-Feng Huang) ； 周宜宏(Yi-Hong Chiou) ； 許紋銘(Wen-Ming Hsu)

《中華民國眼科醫學會雜誌》 46卷3期 (2007/09) Pp. 277-282

https://doi.org/10.30048/ACTASOS.200709.0014

摘要

目的：報告一例類肉瘤病患其疾病侵犯全身多重器官。
方法：病例報告。
結果：27歲年輕女姓發生雙眼葡萄膜炎。三個月後發生胸悶現象，胸部電腦斷層顯示肺門淋巴結擴大，縱隔腔鏡切片檢查報告出非乳酪壞死性肉芽腫性發炎反應。將其它各類會産生肉芽腫性發炎反應之疾病排除後，診斷為類肉瘤症。九個月後，病患右頸出現許多結節並再次接受切片化驗，病理報告同樣顯示淋巴結並再次接受切片化驗，病理報告同樣顯示淋巴結之非乳酪壞死性肉芽腫性發炎。超音波導引切片下證實類肉瘤侵犯腮腺。在約四年的追蹤觀察期間，雖然病患定期接受口服類固醇及環　靈素之治療，病患仍然斷斷續續發生包括視力模糊，腹痛，胸悶及頭痛等等全身多器影響之症狀。葡萄膜炎出現過三次，甚至在最後一次的追蹤檢查發現雙眼的前房及玻離體內發炎細胞。病患在最後一次檢查時的最佳矯正視力為右眼零點七左眼零點五。
結論：類肉瘤是一種全身系統之性發炎反應，其可侵犯身上任何器官而産生各種症狀。我們提出一位以雙眼葡萄膜炎為初始症狀，繼而侵犯胸內及胸外淋巴結，神經系統，肌肉骨骼系統及腮腺等多器官。而腮腺之侵犯在文獻上僅出現在大約十分之一的類肉瘤病患中，且從未有台灣的病例被報導過。

並列摘要

Purpose: To present a case of sarcoidosis with multiple organ involvement.
Methods: An observational case report
Results: A 27-year-old female experienced bilateral uveitis. Three month later, she suffered from chest tightness and computed tomography (CT) scan revealed enlargement of lymph nodes in mediastinal, hilar and subcarinal region. Mediastinoscopic biopsy was performed, which disclosed non-caseating granulomatous inflammation. Diagnosis of sarcoidosis was made after excluding other granulomatous diseases. Nine months later, histopathologic finding of multiple palpable masses over her right neck revealed lymphoadenopathy with non-caseating granulomatous inflammation. Parotid gland involvement was also confirmed by sono-guide biopsy. During the four-year follow up period, the patient suffered from several episodes of abdominal pain, chest tightness headache and arthralgia constantly despite continuous immunosupressent therapy including oral steroid and cyclosporine-A. Uveitis recurred three times during this period. At the end of the follow up, cells were noted in anterior chamber of both her eyes and the best-corrected visual acuity was 6/8.6 in her right eye and 6/12 in her left eye.
Conclusions: Sarcoidosis is a systemic chronic inflammatory process which can involve many organs and present with various symptoms. Herein, we present a case of sarcoidosis initially involving the eyes, followed by involving intra-and extrathoratic lymph nodes, central nerve system (CNS), musculoskeletal system, skin, as well as parotid gland, which occurs only about in 10% of patients with sarcoidosis, and has never been reported in Taiwan before.

並列關鍵字

non-caseating granulomatous inflammation ； parotid gland ； sarcoidosis ； uveitis