サルコイドージスの臨床的研究第2報特殊症例の検討
1980 年 55 巻 1 号 p. 19-28
詳細
1980 年 55 巻 1 号 p. 19-28
In 167 cases with sarcoidosis, involvements of eyes and bone, and unusual cases of acute onset type have been reported.
1. It is clinically very important to suspect the diagnosis of sarcoidosis from ocular findings. In our series intraocular lesions occured in 101 of 146 patients with sarcoidosis (69.2%) and were found more frequently than other reports. All patients with characteristic ocular involvement were finaly established their diagnosis as sarcoidosis by the histological examination, so we considered that not only bilateral hilar adenopathy (BHL) on chest roentgenogram but also four or more active signs of ocular findings are important criteria for the diagnosis of sarcoidosis.
2. In 7 of 130 patients with sarcoidosis, serum calcium levels were elevated at the time of diag nosis. Hypercalcemia had been persisted in only one patient, and there was no significant difference between patients with sarcoidosis and control subjects in the frequency of hypercalcemia.
3. We proposed the new diagnostic criteria of bone lesions in sarcoidosis. In 18 of 76 patients, characteristic roentgenographic lesions were revealed in the fingers and/or hand. Bone biopsy were performed in five patients, and epithelioid cell granuloma was found histologically in only one patient.
4. Nine cases of so-called acute on-set sarcoidosis were reported. Most of them were adolescent, with BHL on chest X-ray film and markedly inflammatory reactions such as the increased erythrocyte sedimentation rate, leucocytosis with a shift to the left and strongly positive CRP reaction. The responseto corticosteroid therapy was satisfactory and the prognosis of these patients was favourable.
5. Although the lung was affected in more than 88% of patients with sarcoidosis, there were 12% of sarcoidosis without any evidence on chest X-ray film. On the other hand 6 patients with BHL who were suspected sarcoidosis were pneumoconiosis (4), tuberculosis (1) and anthracosis. It was suggested that the diagnosis of sarcoidosis should be made histologically using tissue biopsy specimens, and the presence of BHL should not be overestimated.
