ABSTRACT
Aims: Endobronchial involvement may occur in patients with sarcoidosis. Although the prevalence of bronchial abnormalities is high, there are no firm data establishing the clinical features and prognosis of sarcoidosis in these patients. The aim of our study was to define the clinical characteristics and prognosis of patients with endobronchial sarcoidosis. Methods: Clinical and laboratory findings of 44 patients with endobronchial sarcoidosis and 46 patients without endobronchial involvement seen at our institution, were evaluated retrospectively. The patients fulfilled clinical, radiologic or both features of sarcoidosis supported by the histopathologic evidence of noncaseating granulomas. Six to ten bronchial biopsies were taken from each patient. The sample was considered positive if it demonstrated noncaseiting granulomas with negative bacterial, fungal and mycobacterial cultures. Results: Bronchial biopsy was more positive in 84% of the abnormal appearing airways, biopsy provided diagnostic tissue in 32% of the normal appearing mucosa. The most frequent bronchoscopic finding was miliary infiltration followed by nodular and erythematous lesions. Serum ACE, serum and urinary Ca levels were higher (51.4±14.3 IU/L vs 37.3±15.1 IU/L, p<0.01; 8.42±3.6 mg/dL vs 10.8±2.9 mg/dL, p<0.01; 244.9±32.4 mg/day vs 379.6±36.8 mg/day, p<0.01) in patients with endobronchial involvement. There was no significant difference between FEV1, FVC, TLC and DLCO/VA. The extrapulmonary organ involvement (p<0.02) and progressive disease (p<0.03) was more frequent in patients with endobronchial disease. Conclusion: Endobronchial involvement in sarcoidosis appears to be a significant predictive risk factor for progressive disease. Extrapulmonary organ involvement was also higher in these patients contributing to a worse prognosis.
ABSTRACT
BACKGROUND: Sarcoidosis is a systemic granulomatous disease of unknown aetiology. Pleural effusion is very rare in sarcoidosis. In cases with pleural effusion, usually other etiologic factors such as tuberculosis, heart failure, renal failure and malignancy should be considered. METHODS: We retrospectively reviewed the records of 512 sarcoidosis patients followed up at Ceraphasa Medical Faculty, Internal Medicine-Respiratory Disease Department, Turkey. RESULTS: Only four patients with pleural effusion were documented, in three of them it was due to tuberculosis. The patients were negative for microbiological tests regarding tuberculosis and tuberculin tests as well, when the diagnosis of sarcoidosis was made. With the occurrence of effusion tuberculin tests became positive. Acid-fast bacilli (AFB) was cultured in pleural fluid and biopsy materials. After addition of antituberculosis therapy, pleural effusion regressed in all the three cases. CONCLUSIONS: In a sarcoidosis patient with no active disease activity who present with a pleural effusion, if other causes are excluded, it is advisable to start anti-tuberculosis therapy since sarcoid pleural effusion is a rare form of disease occurring at advanced stage of disease. Moreover, corticosteroid therapy renders patients susceptible to tuberculosis. Tuberculin conversion could be a clue to diagnosis in these patients.