Sarcoidosis

 

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SARCOIDOSIS OF LUNG

Sarcoidosis is a rare disease caused by inflammation. It usually occurs in the lungs and lymph nodes, but it can occur in almost any organ. Sarcoidosis in the lungs is called pulmonary sarcoidosis. It causes small lumps of inflammatory cells in the lungs.There is no cure for sarcoidosis, but most people do very well with no treatment or only modest treatment. In some cases, sarcoidosis goes away on its own.  But, if they don’t heal, the lung tissue can remain inflamed and become scarred and stiff. This is called pulmonary fibrosis. It changes the structure of the lungs and can affect your breathing. Bronchiectasis can also occur. This is when pockets form in the air tubes of the lung and become infected. But, these problems are not common.

symptoms of pulmonary sarcoidosis?

Most people with sarcoidosis do not have symptoms and probably don't know they have the disease. It can affect many organs, causing a variety of symptoms. Pulmonary sarcoidosis can reduce the amount of air the lungs can hold and cause lung stiffness.

The following are the most common symptoms of pulmonary sarcoidosis. However, each person may experience symptoms differently. Symptoms may include:

• Shortness of breath, which often gets worse with activity
• Dry cough that will not go away
• Chest pain
• Wheezing

Sarcoidosis can also cause symptoms not directly related to the lungs, such as:

• Extreme tiredness
• Fever
• Inflammation of the eyes and pain, burning, blurred vision, and light sensitivity
• Night sweats
• Pain in the joints and bones
• Skin rashes, lumps, and color changes on face, arms, or shins
• Swollen lymph nodes
• Weight loss

The symptoms of pulmonary sarcoidosis may look like other conditions or medical problems. Talk with your healthcare provider for a diagnosis.

Causes

Doctors don't know the exact cause of sarcoidosis. Some people appear to have a genetic predisposition to develop the disease, which may be triggered by bacteria, viruses, dust or chemicals.

This triggers an overreaction of your immune system, and immune cells begin to collect in a pattern of inflammation called granulomas. As granulomas build up in an organ, the function of that organ can be affected.

Risk factors

While anyone can develop sarcoidosis, factors that may increase your risk include:

• Age and sex. Sarcoidosis can occur at any age, but often occurs between the ages of 20 and 60 years. Women are slightly more likely to develop the disease.
• Race. People of African descent and those of Northern European descent have a higher incidence of sarcoidosis. African-Americans are more likely to have involvement of other organs along with the lungs.
• Family history. If someone in your family has had sarcoidosis, you're more likely to develop the disease.

Complications

Sometimes sarcoidosis causes long-term problems.

• Lungs. Untreated pulmonary sarcoidosis can lead to permanent scarring in your lungs (pulmonary fibrosis), making it difficult to breathe and sometimes causing pulmonary hypertension.
• Eyes. Inflammation can affect almost any part of your eye and may cause damage to the retina, which can eventually cause blindness. Rarely, sarcoidosis also can cause cataracts and glaucoma.
• Kidneys. Sarcoidosis can affect how your body handles calcium, which can lead to kidney stones and reduce kidney function. Rarely, this can lead to kidney failure.
• Heart. Cardiac sarcoidosis results in granulomas in your heart that can disrupt heart rhythm, blood flow and normal heart function. In rare instances, this may lead to death.
• Nervous system. A small number of people with sarcoidosis develop problems related to the central nervous system when granulomas form in the brain and spinal cord. Inflammation in the facial nerves, for example, can cause facial paralysis.

Acute graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic cell transplantation (HCT) that classically presents in the early post-transplantation period or in the late post-transplantation period after the administration of donor lymphocyte infusions. It is thought to be primarily a T cell-mediated disease that occurs when immune cells transplanted from a non-identical donor (the graft) recognize the transplant recipient (the host) as foreign, thereby initiating an immune reaction that causes disease in the transplant recipient. The skin, gastrointestinal tract, and liver are the principal target organs in patients with acute GVHD.

Clinically significant acute GVHD occurs in 9 to 50 percent of patients who receive an allogeneic HCT from a genotypically HLA-identical sibling, despite intensive prophylaxis with immunosuppressive agents, such as methotrexate, cyclosporine, corticosteroids, mycophenolate mofetil, or anti-thymocyte globulin. Acute GVHD is more common following HCT from matched unrelated donors and haploidentical donors. (See "Donor selection for hematopoietic cell transplantation".)

The management of acute GVHD will be reviewed here. Specific recommendations for the prevention and diagnosis of GVHD are discussed separately. (See "Prevention of acute graft-versus-host disease" and "Clinical manifestations, diagnosis, and grading of acute graft-versus-host disease".)