Pulmonary Sarcoidosis Vs Tuberculosis

[Guest guest]

Introduction:

Sarcoidosis with a prevalence of 10/100,000, is a multisystem disease

of unknown etiology characterized by non-caseating granulomas.i It

involves virtually any organ, lungs, thoracic lymph nodes, skin

liver, central nervous system, eyes, kidneys and heart, and is more

common in Afro-Americans. There is no sex predilection but some

manifestations of the disease are more common is females. ² It begins

in the third or fourth decade and tends to be rare in children and

the elderly.? We are presenting a case of sarcoidosis of the lungs

which should be considered in the differential diagnosis of

tuberculosis, common in countries like Pakistan.

 

Discussion:

Considering the common disease first which is tuberculosis, long-

standing history of low grade fever, weight loss and persistent cough

not responding to anitibiotics along with raised ESR and positive PPD

(13 mm) supports tuberculosis put PPD is not reliable in developing

countries as a tool for diagnosis.

 

Diagnostic procedure performed was an endobronchial biopsy. ²

Histopathological examination showed multiple granulomas, composed of

epitheloid histiocytes, with occasional Langerhan's giant cell and no

necrosis. According to one study endobronchial biopsy increased the

yield of fibreoptic bronchoscopy by 20.6%.4 Fungal stain, AFB stains

and cultures, were negative (Table II).

 

The patient had X-ray findings consistent with stage II disease. 1,5

Unilateral hilar adenopathy is an atypical manifestation of

sarcoidosis in initial stage. 6 Her ACE level was raised about three

folds, serum calcium was in upper normal range and ESR was

persistently raised (Table I) supported by radiological findings,

which favour sarcoidosis. PPD is negative in sarcoidosis are anergic

to PPD tuberculin but distribution of memory T-cells in the blood and

humoral immune response are normal and opportunistic infections are

rare.¹

 

Fifty percent of sarcoid cases have clinically silent involvement of

organs, which is one of the hallmarks.¹ 20-40% of symptomatic

patients have respiratory symtoms and 10-40% have eye pain, rashes

arthralgia and other symptoms while 20-30% with constitutional

symptoms like weight loss and fatigue.¹

 

Sarcoidosis may present atypically as Lofgrens and HeerFordt's

syndrome.¹ Sarcoidosis in younger patients with spontaneous remission

and less than two years duration of symptoms are classified as

subacute while chronic form have more than two years duration with

insidious onset and presents with constitutional symptoms, pulmonary

fibrosis and nephrocalcinosis.¹

 

In one study in which histopathological diagnosis required presence

of non-caseating granuloma, bronchoscopic biopsy yielded diagnosis in

60% of patients with stage I disease, tranbronchial needle aspiration

yielded diagnosis in 53% and two procedures in combination yielded

83% of diagnosis. 7,8 In stage II disease probability of obtaining a

positive result with a single specimen was 46%, the yielded with more

specimens followed a logarithmic curve and increased to 90% with four

specimen, at which point the yield approached a plateau for

additional specimen. 7,8 The suggests that four biopsy specimens are

sufficient to make diagnosis. Biopsy of gastrocnemius muscle is

another sensitive and specific tool for diagnosis. 9 If

transbronchial biopsies are non-diagnostic, mediastinal lymph node

biopsies are diagnostic in 8-90% of case. 10 Finally , the patient

was kept on steroids (Deltacortil) 40mg/day in divided doses and

He/She responded well with remarkable improvements. 11 His/Her ESR

came down to 13mm, chest X-ray showed remarkable improvement as

infiltrates and bilateral hilar adenopathy disappeared altogether.

 

We kept His/Her on the same dose of Deltacortil till 8 weeks, and

then it was trapered off to 7.5mg/day without recurrence.

 

 

© Dr. D.S. Merchant Resident Medicine AKUH

Gold Medalist (Anatomy & Histology)

www.ehealthguide.info & www.blogsbasket.com

www.dubaistock.info & www.blog2read.com

[Guest guest]

In the last decade, the mechanism driving sarcoidosis has been

researched, identified and a cure found. Medicine simply hasn't yet

caught up with the science of what is essentially a parasitic

invasion of the white cells by micro-organisms which have tricked the

immune system into not killing them. The whole process is driven by

the parasitic bugs causing overproduction of the secosteroid form of

vitamin D in order to evade the normal killing response of phagocytic

white cells. See the two website references below for the intelligent

and elegant research that has been done by microbiologists e.g. Lida

mattman (Nobel Prize nominee), Janet Wirostko, Andrew Wright, for the

microbiology, and Trevor and Frances Marshall, who developed the

treatment protocol that actually works.

 

Prednisolone and other synthetic steroid treatments suppress the

problem for some years, and whilst it appears to solve the problem in

the short term, the long-term outcome for people with sarcoidosis who

have steroid treatment is in fact worse over time - according to a US

government sponsored ACCESS study of long-term outcomes in

sarcoidosis. You can find the links and explanation of this study on

the Marshall Protocol website.

 

The Marshall Protocol also is being used by people with other immune

conditions which may turn out to have an occult bacterial cause, e.g.

CFS/ME, rheumatoid arthritis, among others.

 

Have a look at two websites which give you all the details and

science involved.

 

www.sarcinfo.com

www.marshallprotocol.com

 

Morag Holden

currently undergoing treatment for sarcoid using up-to-date

information!

>