Sarcoidosis is a multi-organ inflammatory disorder characterized by the presence of non-caseating granulomas primarily affecting the lungs. The pathogenesis of sarcoidosis has not been fully clarified. In recent years, studies have suggested that a variety of pathogen infections, including Mycobacterium tuberculosis, Propionibacterium acnes, fungi, viruses, may be related to the occurrence and progression of sarcoidosis. This article reviews the researches on sarcoidosis and pathogen infection, aiming to explore the potential role of pathogen infection in the pathogenesis of sarcoidosis and provide another direction for the treatment of sarcoidosis.
ObjectiveTo assess the prognosis of asymptomatic pulmonary sarcoidosis with normal lung function. MethodsEighty-two patients with asymptomatic pulmonary sarcoidosis,diagnosed in Guangzhou Institute of Respiratory Diseases between July 2007 and November 2013,were followed for 24 months.The clinical data were collected and analyzed. Results31.7% of the patients showed spontaneous remission without therapy,whereas 39.0% deteriorated and 29.3% remain stable.There was no significant difference between the remission group and the progressive sarcoidosis group with regard to FEV1.17.1% of patients in the progressive sarcoidosis group had a decline in FEV1,while 73.8% had a reduced FVC,and 28.3% had a reduced DLCO.At the beginning of observation,TNF-α level was higher in the progressive sarcoidosis group compared with the remission group and the stable group[(173.5±37.8) μg/mL vs.(102.6±82.7) μg/mL and(131.7±57.9) μg/mL,P<0.05].In the progressive sarcoidosis group,TNF-α at the end time of the observation was higher than that at the beginning[(229.2±76.7) μg/mL vs.(173.5±37.8) μg/mL,P<0.05].The neutrophil in BALF was significantly higher in the progressive sarcoidosis group compared with the remission group[(10.6±4.6)% vs.(8.68±5.2)%,P<0.01). There were no significant differences between the progressive sarcoidosis group and the remission group with regard to CD4/CD8 T-cell ratio and the expression of angiotensin converting enzyme(ACE) in lung tissue.Non-necrotizing granulomas rate in endobronchial biopsy was 63.6% in the progressive sarcoidosis group,54.9% in the remission group,and 58.4% in the stable group,respectively,without significant difference between three groups(P>0.05) but was significantly different between three groups at the end time of the observation(69.1% vs.12.7% and 36.2%,P<0.05). ConclusionNearly 40% asymptomatic pulmonary sarcoidosis are likely to deteriorate.The increase of TNF-α and BALF neutrophils may indicate the progress of sarcoidosis.
ObjectiveTo improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. MethodsTo analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. ResultsThe patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. ConclusionSarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.
Objective To investigate the clinical features, chest imaging manifestations, pathological changes, diagnosis and treatment of sarcoidosis with pleural effusion as the initial manifestation, and to analyze the possible causes of misdiagnosis, so as to help clinicians improve their understanding of sarcoidosis with pleural effusion as the initial manifestation, and reduce the rate of clinical misdiagnosis and missed diagnosis. Methods The general data, clinical manifestations, imaging examinations, pathological findings and outcomes of 4 patients with sarcoidosis with pleural effusion as the first manifestation admitted to Ningxia Medical University General Hospital from January 2019 to December 2020 were retrospectively analyzed. Results Out of these patients, 3 were female and 1 was male, with an average age of 50.3 years. The main clinical features were cough, expectoration, chest tightness, shortness of breath and other common respiratory symptoms. Chest CT indicated right pleural effusion. After admission, closed thoracic drainage, tracheoscopy, thoracoscopy, pleural biopsy and cervical lymph node biopsy were performed to obtain pathology. Combined with imaging and pathology, diagnosis was made. After hormone therapy, symptoms and imaging were improved. Conclusions Sarcoidity-related pleural effusion is relatively rare as the first episode, with no specific clinical symptoms and no specific physical and chemical properties of pleural effusion. Non-caseous granulomatous lesions can be found pathologically, and the diagnosis needs to rely on clinical, imaging and pathological comprehensive judgment.