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Sarcoidosis: Pulmonary Sarcoidosis
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For the remainder, sarcoidosis is considered to be chronic, never quite going completely into remission, even with treatment. Serious pulmonary sarcoidosis with life-threatening symptoms, neurosarcoidosis, and cardiac sarcoidosis are most commonly this type. For these people, sarcoidosis alters what has been known as normal. Even with the more serious forms of sarcoidosis, though, life can be relatively normal. The patient with chronic sarcoidosis may need to make some changes to accommodate their new limitations, but they can continue most if not all of their normal activities, even going on to have children. On-going treatment for sarcoidosis can have an impact on normal life, from side effects to scheduling regular visits to receive one's treatment.
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Sarcoidosis occurs throughout the world in any race. It is more commonly seen in blacksthan whites, primarily people of northern European descent in the latter case. Pulmonaryinvolvement is the most common presentation of sarcoidosis.
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In 1984 Gary Hunninghake demonstrated the spontaneous release of interleukin-1 by alveolar macrophages from patients with sarcoidosis compared with normals and those with idiopathic pulmonary fibrosis. The assay used was a functional assay based on ability to induce proliferation of thymocytes. T lymphocyte activation is manifested by active proliferation, formation of rosettes with sheep erythrocytes, and spontaneous release of Migration Inhibition Factor, Macrophage Chemotactic Factor, IL-2, gamma IF and factors that stimulate B cells to differentiate into immunoglobulin-secreting cells. Also in 1984 Gary Hunninghake demonstrated the ability of lymphocytes to release Il-2 based on an assay of cellular proliferation. Proposed mechanisms: IL-1 and IL-2 are chemotactic for blood T-cells and this increased accumulation in the lung may account for the relative peripheral blood T-lymphopenia often observed. Activated lung T-cells release monocyte chemotactic factor which may attract blood monocytes to the lung and specifically to sites of disease.
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Consultation with the Rheumatology, Pulmonary, and Dermatology services agreed with the diagnosis of sarcoidosis and the patient was started on prednisone. However, because of the patient's newly positive PPD and CXR findings, she was ... started on four drug therapy for tuberculosis. Her sputum cultures were negative for Mycobacterium tuberculosis, but her skin biopsy cultures were positive for tuberculosis. She completed her TB therapy. Her facial lesion improved significantly with steroids, but the patient remained tracheotomy dependent. Her steroids were tapered slowly over the next year.
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In sarcoidosis, the immune system starts to attack the body's own tissues, forming small lumps called granulomas. These are like small scars that interfere with the normal function of the organ attacked by the disease. Even after treatment, the scarring can remain and can continue to have some effect on organ function. For example, sarcoidosis of the eyes can cause blindness if not detected and treated promptly, and pulmonary sarcoidosis can cause permanent scarring that interferes with breathing during exercise even with treatment. The majority of people diagnosed with sarcoidosis lead relatively normal lives after diagnosis, with or without treatment, despite the lack of cure.
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Any of the symptoms listed in the previous section may lead a physician to consider sarcoidosis. Sarcoidosis is initially diagnosed based on physical examination, laboratory tests, pulmonary function studies, and chest X ray. When enlargement of lymph glands in the center of the lungs is seen on the X ray, sarcoidosis may be suspected. To confirm the diagnosis, a biopsy is usually performed on any of the affected organs or from material in a granuloma on the skin.
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Pulmonary Sarcoidosis