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EDITORIAL
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 1

Sarcoidosis


Department of Respiratory Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India

Date of Submission30-May-2022
Date of Acceptance11-Jun-2022
Date of Web Publication12-Aug-2022

Correspondence Address:
R Narasimhan
Department of Respiratory Medicine, Apollo Hospitals Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/japt.japt_15_22

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How to cite this article:
Narasimhan R. Sarcoidosis. J Assoc Pulmonologist Tamilnadu 2022;5:1

How to cite this URL:
Narasimhan R. Sarcoidosis. J Assoc Pulmonologist Tamilnadu [serial online] 2022 [cited 2022 Oct 3];5:1. Available from: http://www.japt.com/text.asp?2022/5/1/1/353741



Sarcoidosis is a multisystem disorder characterized by heightened immunological response with a special predilection for respiratory system. Because lung is the most commonly affected organ, it is a small surprise that many pathogenic etiologies have come out of the lung biopsies. This is because of the reason that it closely resembles tuberculosis (TB), another multisystem disorder that predominantly affects lungs. The only difference is that it is the lymph nodes affected first in sarcoidosis and lungs affected first in TB. Although the etiology of sarcoidosis is not well known, last three decades has seen many advances in various aspects of sarcoidosis that includes diagnosis, imaging techniques, sampling techniques, and therapeutic strategies.

Next to lungs, it affects the eye, skin, and kidneys commonly. Most of the pulmonologists see it or share it with ophthalmologists. The most common dilemma of the ophthalmologist is the safety of steroids in this condition, and the fear is the flare up of TB in the absence of definitive of diagnosis of sarcoidosis. Mantoux test and Interferon Gama Release Assay Test and IGRA can be used to exclude TB. These tests are hardly used to diagnose but can be used to rule out TB if the patient is not immunocompromised. Hence, the job of the pulmonologist is not easy as one can be blamed for starting steroids in TB and for not starting TB treatment although it looks like sarcoidosis. This is a common problem in India and in Asian countries where TB is endemic. A holistic approach alone would do justice to the patient.

Another organ that is rarely affected by sarcoidosis is pleura. Less than 2% of patients are affected by sarcoidosis, and the most common presentation is lymphocytic exudative pleural effusion with noncaseating granulomas. The review article on pleural sarcoidosis clearly discusses various aspects of it. This highlights the importance of the statement that all lymphocytic exudative effusions are not tuberculous and need pleural biopsy to diagnose.

It is well known about the four stages of sarcoidosis. It is also to be kept in mind that the stages do not mean gradual progression. The follow-up patients with sarcoidosis are fraught with problems. Most of the stage I sarcoidosis are asymptomatic and resolve spontaneously, stage II sarcoidosis resolves in 49% of patients, and stage III sarcoidosis resolves in 20% of cases.[1] Lack of resolution of pulmonary opacities should not be taken as lack of improvement. Acute sarcoidosis with erythema nodosum or skin lesions suggestive of sarcoidosis with lung disease has good prognosis. Sarcoidosis is one of the few diseases where clinicoradiological dissociation is profound. One would also notice that saturation drops are infrequent during bronchoscopies.

Recent pulmonary interventions are boon to the diagnostic armamentarium. The use of Endobronchial Ultrasound (EBUS) and cryobiopsy of the lung tissue has obviated the use of open lung biopsy for the diagnosis. The ease with one sees granulomas in the normal-looking bronchial mucosa is surprising. The diagnostic yield is high if one combines EBUS Transbronchial Needle aspiration (TBNA ), endobronchial biopsy, and transbronchial lung biopsies for sarcoidosis.

Having said this one has to clearly remember that sarcoidosis is a diagnosis of exclusion and not otherwise especially in India.



 
  References Top

1.
Current Concepts of the Pathogenesis of Sarcoidosis1,2.” American Review of Respiratory Disease, 135(3), pp. 747–760,  Back to cited text no. 1
    




 

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