Sarcoidosis and tuberculosis: a connection to the human leukocyte antigen system.

Infectious, genetic factors, and autoimmunity have been considered as potential causes of sarcoidosis (SA). Pathological similarities between SA and tuberculosis (TB) suggest M. tuberculosis antigen(s) as causative agent(s). Our published comparative analysis of the human leukocyte antigens (HLA) system in patients with SA or TB in the same ethnic group revealed that some antigens were connected with high risk of developing of SA or TB, but other were comparable in both patient populations. Is it possible that the predominating occurrence of HLA antigens characteristic for TB may cause tuberculosis in patients with SA? To answer this question we evaluated the HLA class I and II alleles frequency by PCR amplification with sequence-specific primers in three women with histopathologically proven pulmonary SA, who developed bacteriologically confirmed TB on a corticosteroids (CS) therapy. Analysis of HLA in every case separately revealed a trend for higher occurrence of both alleles predisposing and protecting from TB than SA, in comparison with healthy individuals in our previously mentioned HLA genotyping study. Overall, the number of alleles predisposing to TB was statistically greater than the number of alleles connected with a high risk of developing SA. Also, the frequency of protecting alleles was statistically higher for TB than for SA. Therefore, SA in these patients developed at first, and the presence of additional environmental factors, e.g., age, CS might decrease an immune response and provoked TB. There is a possibility that the occurrence of HLA antigen more associated with high risk of developing TB than SA causes the development of tuberculosis in our patients with sarcoidosis.

Association between SLC11A1 (formerly NRAMP1) and the risk of sarcoidosis in Poland.

Sarcoidosis (SA) is a systemic granulomatous disorder of unknown etiology characterized by T helper 1-type inflammatory responses at sites of disease with signs of B cell hyperactivity. Like rheumatoid arthritis and diabetes, an infectious etiology has frequently been postulated but no single infectious trigger definitively identified. Polymorphic alleles at SLC11A1 have previously been associated with susceptibility to both the putative infectious agents and to these autoimmune disorders. We therefore investigated its candidacy as a genetic determinant of SA in Poland in an association-based study comparing 86 SA patients with 85 tuberculosis (TB) patients and 93 control subjects. The functional promoter (GT)(n) polymorphism and four of 10 other single nucleotide or insertion/deletion polymorphisms genotyped across SLC11A1 were informative in our sample. Consistent with previous autoimmune disease studies, allele 3 at the functional (GT)(n) promoter region repeat polymorphism was significantly associated with SA when compared with healthy controls (odds ratio 1.68; 95% CI: 1.01-2.81; P=0.04) or with TB patients (odds ratio 1.69; 95% CI: 1.042-0.78; P=0.03).

[The case of central pontine myelinolysis in an alcohol dependent male]. / Przypadek mielinozy srodkowej mostu u mezczyzny uzaleznionego od alkoholu.

Long-term alcohol abuse can lead to numerous central nervous system lesions, among them central pontine myelinolysis. In this paper, the first in Polish literature case of central pontine myelinolysis in an alcohol dependent male, clinically diagnosed, and confirmed by nuclear magnetic resonance with one year follow-up has been presented. The patient, 49 years old, was admitted to Addiction Treatment Unit, Department of Psychiatry in Bydgoszcz. After admission he manifested clouded consciousness, dysphasia, hyponatremia and neuropsychological abnormalities which showed brain stem lesion. He had no significant abnormalities in CT. Nuclear magnetic resonance revealed triangular hypointensive lesion 10 x 5 mm in central pontine region. One year after admission to Addiction Treatment Unit he still has troubles with walking and swallowing. He has bilateral pyramidal symptoms and emotional lability. He was treated with vinpocetine (0.075 g per day), piracetam (4.8 g per day) and chlorprotixen (0.09 g per day). He was admitted to Psychiatric Ward because of a suicidal attempt as a manifestation of mood disorder due to general medical condition.