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      Syndrome de Heerfordt: à propos d’une observation et revue de la littérature Translated title: Heerfordt’s syndrome: about a case and literature review

      case-report

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          Abstract

          Le syndrome de Heerfordt est une manifestation rare de la sarcoïdose associant dans sa forme classique une uvéite, parotidomégalie, paralysie faciale et fièvre. C'est une forme active de la maladie dont le diagnostic est facilité par la biopsie salivaire. Il s'agit d'une observation clinique d'une patiente âgée de 17 ans présentant une uvéite, une parotidomégalie droite et une paralysie faciale droite d'apparition brutale. Après un bilan biologique et une imagerie (échographie parotidienne), une biopsie des glandes salivaires accessoires a conduit au diagnostic de sarcoïdose. Un bilan pré thérapeutique a permis d'instituer une corticothérapie par voie orale avec une évolution favorable et rémission totale. Le syndrome de Heerfordt est une forme clinique rare de sarcoïdose avec un profil évolutif favorable dans la majorité des cas. Il nécessite une approche diagnostique précise (éliminer les diagnostics différentiels surtout les formes incomplètes) en insistant sur les progrès thérapeutiques dans ce domaine.

          Translated abstract

          Heerfordt's syndrome is a rare manifestation of sarcoidosis combining uveitis, parotidomegaly, facial paralysis and fever in its classic form. It is an active form of the disease whose diagnosis is facilitated by salivary gland biopsy. We conducted clinical observation of a 17-year-old female patient with uveitis, right parotidomegaly and right facial paralysis characterized by violent onset. After laboratory tests and imaging exam (parotid ultrasound), biopsy of minor salivary glands established the diagnosis of sarcoidosis. A pre-therapeutic assessment allowed for the initiation of oral corticosteroid therapy with favorable outcome and total remission. Heerfordt's syndrome is a rare clinical form of sarcoidosis, with favorable outcome in most cases. Specific diagnostic approach (excluding differential diagnoses, especially the incomplete forms) is necessary, based on therapeutic advances in this area.

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          Most cited references18

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          Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide.

          Although glucocorticosteroids are considered the first-line treatment in sarcoidosis, refractory cases require alternatives, such as methotrexate (MTX). The aim of this study was to develop, on behalf of the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG), multinational evidence-based recommendations for the use of MTX in sarcoidosis for routine clinical practice.
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            Salivary Gland Pathology in IgG4-Related Disease: A Comprehensive Review

            IgG4-related disease (IgG4-RD) is a rare fibroinflammatory condition that can affect almost any organ, characterized by swollen lesions and often by eosinophilia and elevated serum IgG4 concentrations. The diagnosis of IgG4-RD is a challenging task: in fact, single or multiple organs can be affected and clinical, serological, and histological findings can be heterogeneous. In IgG4-RD, the involvement of salivary glands is observed in 27% to 53% of patients. Several organ-specific conditions, now recognized as different manifestations of IgG4-related sialadenitis (IgG4-RS), were viewed in the past as individual disease entities. The study of salivary glands may sometimes be complex, because of the number of pathological conditions that may affect them, often with overlapping clinical pictures. Integration of different imaging techniques is often required in the case of swelling of salivary glands, even though biopsy remains the gold standard for a definite diagnosis of IgG4-RS. Thus, in this review, we discuss new insights in the pathogenesis of IgG4-RD, focusing on its clinical aspects and the tools that are currently available for a correct differential diagnosis when the salivary glands are involved.
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              HLA-DRB1* alleles and symptoms associated with Heerfordt's syndrome in sarcoidosis.

              Heerfordt's syndrome (HS) consists in its complete form of uveitis, parotid or salivary gland enlargement and cranial nerve palsy. The objective of the present study was to analyse if there are also links between HLA-DRB1* alleles and HS, as it is a specific phenotype of sarcoidosis. 1,000 patients with sarcoidosis, out of whom 83 had symptoms associated with HS, were included in the study together with a group of 2,000 healthy individuals from the same population, matched for sex and age. HLA-DRB1* allelic groups were determined for all individuals, and comparisons were made between different disease subgroups and between patients and healthy controls. We found that the HLA-DRB1*04 allele was overrepresented in patients with symptoms associated with HS. 83 (8.3%) of all patients had one or more of the symptoms and 46 (55%) of them were HLA-DRB1*04 positive. 44 (55%) of the patients with ocular sarcoidosis, i.e. the most common symptom associated with HS, were HLA-DRB1*04 positive, compared with 35.9% of healthy controls (p=0.0008), and only 26.6% of the whole group of sarcoidosis patients (p<0.0001). HLA-DRB1*04 seems to protect against overall sarcoidosis but appears to be a significant risk factor for ocular sarcoidosis as well as for other manifestations associated with HS.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                02 October 2020
                2020
                : 37
                : 117
                Affiliations
                [1 ]Service ORL, CHU Annaba Faculté de Médecine, Universite Badji Mokhtar, Annaba, Algérie
                Author notes
                Corresponding author: Smail Kharoubi, Service ORL, CHU Annaba Faculté de Médecine, Universite Badji Mokhtar, Annaba, Algérie. smail.kharoubi@ 123456gmail.com
                Article
                PAMJ-37-117
                10.11604/pamj.2020.37.117.25338
                7755359
                177b97de-e2c0-4fd8-8a9b-eed8890abbc0
                Copyright: Smail Kharoubi et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 August 2020
                : 26 September 2020
                Categories
                Case Report

                Medicine
                granulomatose,parotidomégalie,paralysie faciale,enzyme de conversion,angiotensine,granulomatosis,parotidomegaly,facial paralysis,converting enzyme,angiotensin

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