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Infectious Disorders - Drug Targets

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ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

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Case Report

Heerfordt-Waldenström Syndrome, A Rare Presentation of Sarcoidosis in a Patient with Old Ocular Toxoplasmosis

Author(s): Maryam Mobini, Ahmad Ahmadzade Amiri, Roya Ghasemian , Zhila Torabizadeh and Mahdi Fakhar*

Volume 21, Issue 4, 2021

Published on: 09 September, 2020

Page: [629 - 633] Pages: 5

DOI: 10.2174/1871526520666200909094500

Price: $65

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Abstract

Background: There are similarities between the ophthalmic presentation of toxoplasmosis and sarcoidosis, and there are some concerns of immunosuppressive treatments for sarcoidosis, which may lead to T. gondii reactivation. We report a rare case with acute sarcoidosis (Heerfordt- Waldenström syndrome) with a history of ocular toxoplasmosis from the North of Iran.

Case presentation: The patient was a 36-year-old woman with left painful eye and swollen parotid, right facial paresis, maculopapular rash in left eyebrow and erythema nodosa on both legs. Anti–Toxoplasma IgG antibody was positive, and IgM was not detectable. Radiographic findings on the chest revealed bilateral hilar lymphadenopathy. The initial treatment was sulfamethoxazole- trimethoprim to prevent the recurrence of retinal toxoplasmosis and corticosteroid and mycophenolate mofetil for sarcoidosis. The patient showed clinical and vision improvement without recurrences during three months follow-up.

Discussion: Ophthalmological examinations and laboratory tests to rule out toxoplasmosis could be considered in known cases of sarcoidosis, particularly in ocular sarcoidosis status. To the best of our knowledge, this is the first report of comorbidity of ocular toxoplasmosis/sarcoidosis from Iran and possibly the world.

Keywords: Ocular toxoplasmosis, anti–Toxoplasma antibody, sarcoidosis, comorbidity, heerfordt-waldenström syndrome, imaging findings.

Graphical Abstract

[1]
Ungprasert, P.; Crowson, C.S.; Matteson, E.L. Epidemiology and clinical characteristics of sarcoidosis: an update from a population-based cohort study from Olmsted County, Minnesota. Reumatismo, 2017, 69(1), 16-22.
[http://dx.doi.org/10.4081/reumatismo.2017.965] [PMID: 28535617]
[2]
Jasper, S.; Vedula, S.S.; John, S.S.; Horo, S.; Sepah, Y.J.; Nguyen, Q.D. Corticosteroids as adjuvant therapy for ocular toxoplasmosis. Cochrane Database Syst. Rev., 2017, 1, CD007417.
[http://dx.doi.org/10.1002/14651858.CD007417.pub3] [PMID: 28125765]
[3]
Teh, L.S.; Coombes, G.M.; MacDonald, R.H.; Prescott, R.J.; Dietch, D.M.; Jones, A.K. Acute sarcoidosis: a difficult diagnosis. Rheumatology (Oxford), 2000, 39(6), 683-685.
[http://dx.doi.org/10.1093/rheumatology/39.6.683] [PMID: 10888719]
[4]
Levy, Y.; Hayek, T.; Finkelstein, R. Sarcoidosis mimicking toxoplasmosis with severe hypercalcaemia and normal 1,25-dihydroxy vitamin D. J. Intern. Med., 1996, 240(3), 165-167.
[http://dx.doi.org/10.1046/j.1365-2796.1996.24850000.x] [PMID: 8862127]
[5]
Misra, D.P.; Chengappa, K.G.; Mahadevan, A.; Jain, V.K.; Negi, V.S. Sarcoidosis, neurotoxoplasmosis and golimumab therapy. QJM, 2016, 109(12), 817-818.
[http://dx.doi.org/10.1093/qjmed/hcw197] [PMID: 28011850]
[6]
Peres, M.B.; Sousa, J.M.; Nascimento, H. Ocular sarcoidosis masked by positive IgM for toxoplasmosis. Arq. Bras. Oftalmol., 2017, 80(2), 125-127.
[PMID: 28591288]
[7]
Gagnier, J.J.; Kienle, G.; Altman, D.G.; Moher, D.; Sox, H.; Riley, D. CARE Group. The CARE guidelines: consensus-based clinical case report guideline development. J. Clin. Epidemiol., 2014, 67(1), 46-51.
[http://dx.doi.org/10.1016/j.jclinepi.2013.08.003] [PMID: 24035173]
[8]
Carter, C.J. Toxoplasmosis and polygenic disease susceptibility genes: extensive Toxoplasma gondii host/pathogen interactome enrichment in nine psychiatric or neurological disorders. J. Pathogens, 2013, 2013, 965046.
[http://dx.doi.org/10.1155/2013/965046] [PMID: 23533776]
[9]
Prandota, J. Possible critical role of latent chronic Toxoplasma gondii infection in triggering, development and persistence of autoimmune diseases. Int J of Neurolog Res, 2018, 4(1), 379-463.
[http://dx.doi.org/10.17554/j.issn.2313-5611.2018.04.79]
[10]
Okada, H.; Kuhn, C.; Feiller, H.; Bach, J.F. The hygiene hypothesis“ for autoimmune and allergic diseases: an update. Clin. Exp. Immunol., 2010, 160, 1-9.
[11]
Chen, M.; Aosai, F.; Norose, K.; Mun, H.S.; Ishikura, H.; Hirose, S.; Piao, L.X.; Fang, H.; Yano, A. Toxoplasma gondii infection inhibits the development of lupus-like syndrome in autoimmune (New Zealand Black x New Zealand White) F1 mice. Int. Immunol., 2004, 16(7), 937-946.
[http://dx.doi.org/10.1093/intimm/dxh095] [PMID: 15148287]
[12]
Butler, N.J.; Furtado, J.M.; Winthrop, K.L.; Smith, J.R. Ocular toxoplasmosis II: clinical features, pathology and management. Clin. Exp. Ophthalmol., 2013, 41(1), 95-108.
[http://dx.doi.org/10.1111/j.1442-9071.2012.02838.x] [PMID: 22712598]
[13]
Feliciano-Alfonso, J.E.; Vargas-Villanueva, A.; Marín, M.A.; Triviño, L.; Carvajal, N.; Moreno, M.; Luna, T.; Lopez de Mesa, C.; Muñoz-Ortiz, J.; de-la-Torre, A. Antibiotic treatment for ocular toxoplasmosis: a systematic review and meta-analysis: study protocol. Syst. Rev., 2019, 8(1), 146.
[http://dx.doi.org/10.1186/s13643-019-1067-8] [PMID: 31221217]
[14]
Oray, M.; Ozdal, P.C.; Cebeci, Z.; Kir, N.; Tugal-Tutkun, I. Fulminant Ocular Toxoplasmosis: The Hazards of Corticosteroid Monotherapy. Ocul. Immunol. Inflamm., 2016, 24(6), 637-646.
[http://dx.doi.org/10.3109/09273948.2015.1057599] [PMID: 26647176]
[15]
Sabates, R.; Pruett, R.C.; Brockhurst, R.J. Fulminant ocular toxoplasmosis. Am. J. Ophthalmol., 1981, 92(4), 497-503.
[http://dx.doi.org/10.1016/0002-9394(81)90642-5] [PMID: 7294112]
[16]
Rush, R.; Sheth, S. Fulminant toxoplasmic retinochoroiditis following intravitreal triamcinolone administration. Indian J. Ophthalmol., 2012, 60(2), 141-143.
[http://dx.doi.org/10.4103/0301-4738.94059] [PMID: 22446913]
[17]
Denny, M.C.; Fotino, A.D. The Heerfordt-Waldenström syndrome as an initial presentation of sarcoidosis. Proc. Bayl. Univ. Med. Cent., 2013, 26(4), 390-392.
[http://dx.doi.org/10.1080/08998280.2013.11929014] [PMID: 24082416]

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