Bilateral parotitis as the initial presentation of childhood sarcoidosis.
ABSTRACT The differential diagnosis of bilateral parotid gland enlargement in children includes infectious, inflammatory, and neoplastic disorders. We present the case of a 13-year-old male who presented with a 5-week history of bilateral parotid swelling. On exam, both parotid glands were nontender, smooth, and diffusely enlarged. He had slightly elevated inflammatory markers, but other lab results were normal. A neck CT revealed symmetric enlargement of the parotid, submandibular, and sublingual glands. A chest CT revealed scattered peripheral pulmonary nodules and bilateral hilar adenopathy. A parotid gland biopsy showed multiple noncaseating granulomas with multinucleated giant cells surrounded by lymphocytes, consistent with the diagnosis of sarcoidosis. Special stains for acid-fast and fungal organisms were negative. Using this illustrative case, we discuss the differential diagnosis of bilateral salivary gland enlargement in children and review the etiology, diagnosis, clinical manifestations, and treatment of pediatric sarcoidosis.
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ABSTRACT: To document pulmonary function abnormalities in children with sarcoidosis, we reviewed the records of all children with this disease at the North Carolina Memorial Hospital. Spirometry was performed by 34 of 60 children at initial presentation and was repeated by 16 at least 1 yr after presentation (mean, 3.9 yr). Those with and without pulmonary function data available were similar in age, sex, race, and clinical manifestations at presentation. Results indicate that at presentation, 50% of children had the characteristic functional changes of restrictive lung disease (mean % predicted FVC, 79.8 +/- 16.0). Fifteen percent had a FVC of 70 to 80% predicted, 32% had a FVC of 50 to 70% predicted, and 3% had a FVC less than 50% predicted. The TLC and FRC supported the diagnosis of restrictive lung disease. There were 15% who had obstructive changes. Children with auscultatory abnormalities and parenchymal changes on chest radiograph had more severe decrements in pulmonary function; however, specific symptoms did not predict decrements in pulmonary function. There was significant improvement in lung function at the last pulmonary function test performed (mean % predicted FVC, 97.1 +/- 18.8).The American review of respiratory disease 02/1986; 133(1):94-6. · 10.19 Impact Factor
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ABSTRACT: To describe the incidence, clinical presentation and paraclinical findings in childhood sarcoidosis in Denmark, 1979-1994. Patients (n = 5536) with a diagnosis of sarcoidosis were drawn from the nationwide Patient Registry; 81 patients were < or = 15 y of age. The diagnosis of sarcoidosis was reconfirmed in 48/81 (59%) patients. In 35/48 (73%) patients, diagnosis was verified by histology, and in 13 it was substantiated by paraclinical/clinical findings. The series comprised 26 boys and 22 girls (male/female ratio 1.18). Median age at diagnosis was 13 y (range 0.7-15). In 1979-1994 the incidence was 0.29 per 100000 person-years < or = 15 y of age. The incidence was 0.06 in children < or = 4 y of age and increased gradually with age to 1.02 in children aged 14-15 y. General malaise, fever, weight loss, abdominal discomfort, respiratory symptoms, lymphadenopathy and central nervous system symptoms were common; 31% of patients had erythema nodosum, 12.5% sarcoid skin lesions, 25% uveitis/iridocyclitis and 4.2% sarcoid arthritis. Chest X-rays were normal (stage 0) in 10% of patients, and showed pulmonary infiltrates stage I in 71%, stage II in 8.3% and stage III in 8.3%. Lung function tests were examined in 13 patients: 50% had decreased FEV1 and vital capacity, 80% decreased DLCO. Haemoglobin values were normal. Some patients had mild leukopenia, some moderate leukocytosis and a few had moderate eosinophilia. Erythrocyte sedimentation rate was elevated in 40% of the patients. Plasma calcium was elevated in 30% of the patients; 4 patients had severe hypercalcaemia and elevated plasma creatinine, and 1 patient had nephrocalcinosis. Serum angiotensin-converting enzyme was elevated in 55% of the patients. Liver function tests were normal with no sarcoid hepatitis. Urinary examination (glucose, albumin, haemoglobin) was normal in 96% of the patients; the patient with nephrocalcinosis had albuminuria and haematuria. The incidence of sarcoidosis in Danish children is low and increases with age. Sarcoidosis in young children may present clinical features that are different from the appearance of those in older children and often constitute a diagnostic challenge. In older children, the clinical appearance has many features in common with the presentation in adults.Acta Paediatrica 01/2004; 93(1):30-6. DOI:10.1111/j.1651-2227.2004.tb00670.x · 1.84 Impact Factor
Article: SarcoidosisNew England Journal of Medicine 12/2007; 357(21):2153-65. DOI:10.1056/NEJMra071714 · 54.42 Impact Factor