Sarcoidosis in elderly Tunisian patients: about 16 cases Elderly-onset sarcoidosis in Tunisia

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Donia Chebbi
Sameh Marzouk
Mouna Snoussi
Moez Jallouli
Nawrez Gouiaa
Tahia Boudawara
Zouhir Bahloul


sarcoidosis, Elderly subjects, Uveitis, Interstitial lung disease


Background: Sarcoidosis is a systemic granulomatous disease of unknown etiology. It affects mostly young adults. In the elderly, the presentation of this disease is different, often posing positive diagnosis problems.Objectives: We intend to describe the various clinical features and the management of sarcoidosis in elderly patients (age ≥65 years) compared to the younger ones.Methods: We performed a retrospective, descriptive and comparative study in the Department of Internal Medicine in the University Hospital Hedi Chaker, Sfax, Tunisia, between 1996 and 2016.

Results: From a series of 80 patients, we found sixteen patients (20%) with sarcoidosis diagnosed after the age of 65 years. A female preponderance (81,25%) was noted.

Intrathoracic involvement concerned 13 patients (81,3%). Extrapulmonary signs were also frequent (93,8%). The main extrathoracic manifestations were ganglionar involvement (75%), an alteration of the general health (31,3%), hepatic involvement (31,3%), cutaneous involvement (25%) and ocular involvement (25%). Biological manifestations were hypercalcemia, hypercalciuria, lymphopenia and hypergammaglobulinemia noted in respectively 12,5%, 12,5%, 31,3% and 50% of the cases. Angiotensin-converting enzyme level was elevated in 100% of the patients. The tuberculin skin test result was negative in all patients. Lymphadenopathy and cutaneous biopsies were important contributing factors to diagnosis (respectively: 100% and 75% were positive). Oral corticosteroid therapy was required in 50% of cases. Evolution was marked by pulmonary fibrosis in two cases. Satisfactory course of the disease was observed in the other patients.

Conclusion: sarcoidosis should be considered in the differential diagnosis of elderly patients presenting with pulmonary or multisystem disease.


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