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Pediatric sarcoidosis presenting with hypertensive encephalopathy
J Jungthirapanich1, D Watana, P Pongprasit
1Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Summary
Pediatric sarcoidosis presented with hypertensive encephalopathy, organomegaly, and proteinuria. Steroid therapy resolved some symptoms, but hypertension remained challenging, highlighting the complexity of childhood sarcoidosis.
Area of Science:
- Pediatric Rheumatology
- Nephrology
- Pathology
Background:
- Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
- Pediatric sarcoidosis is rare and can manifest with diverse clinical presentations.
- Early diagnosis and management are crucial for favorable outcomes in affected children.
Observation:
- A 3-year-old girl presented with simultaneous hypertensive encephalopathy, subcutaneous nodules, hepatosplenomegaly, and proteinuria.
- Histologic examination confirmed sarcoidosis with non-caseating granulomas in multiple organs, including liver, kidney, lymph node, and skin.
- The patient exhibited significant organ involvement and severe hypertension at initial presentation.
Findings:
- Proteinuria resolved spontaneously, indicating potential for renal recovery.
- Six months of steroid therapy led to the resolution of renal mass and hepatosplenomegaly.
- Despite treatment, cervical lymphadenopathy persisted, and the hypertensive state proved difficult to control, necessitating a multi-drug regimen.
Implications:
- This case underscores the varied and severe manifestations of sarcoidosis in children.
- Effective management of hypertension in pediatric sarcoidosis requires a persistent and often complex therapeutic approach.
- Multidisciplinary care involving rheumatology, nephrology, and cardiology is essential for optimizing treatment strategies and patient outcomes.