Talk:Sarcoidosis

note

First, I would strongly recommend checking out http://www.inspire.com there is an entire support community devoted solely to Sarcoidosis.

Second, Let me clear up a misconception. Diminished lung function and scar tissue in patients with sarcoidosis is a secondary symptom not part of the disease. Sarcoidosis is an unknown and involuntary inflammation of the immune system which can cause granulomas also called nodules in any or all of the vital organs, additionally causes a high susceptibility to any form of topical bacterial of fungal infections. As a result, this can cause a large number of derm conditions as secondary symptoms. This information is posted on a large poster on the wall in the Dermatology department at the Cleveland Clinic Foundation. I will attempt to obtain source information for it.

Rash and irritation can be quite common in patients with Sarcoidosis. This information can be confirmed by the thousands of patients who have been positively diagnosed with the disease and posted it on Inspire.com . The rash does not respond to steroids but rather steroids are prescribed in the use of controlling the Sarcoidosis which can control the disease and reduce the symptoms, but since the long term effects of the steroids is damaging they are used as a last resort when the flare-up of the disease is severe. The rash is best treated by a Dermatologist and in some cases does respond to topical cortico-steroids such as Hydro-Cortisone but the use of steroids in the treatment of Sarcoidosis is a separate issue from the rash.

Lastly having been initially diagnosed with Lymphatic Cancer which was later changed to a diagnosis of Sarcoidosis I can tell you that there is a very clear cut and precise difference between Sarcoidosis and Cancer. "Cancer can not exist in the presence of a granuloma." The exact words from the Thoracic Surgeon after an outpatient procedure.

For any interested in more detailed clinical information it is available from The New England Journal of Medicine, contributed by variouse sources at URL : http://www.nejm.org/doi/full/10.1056/NEJMra071714 —Preceding unsigned comment added by 174.100.135.1 (talk) 03:03, 23 October 2010

Depends a lot what type of rash, but sarcoidosis frequently causes rash. It responds to steroids and, oddly, some types of antibiotics (minocycline). JFW | T@lk —Preceding undated comment added 02:57, 10 March 2005.

New edits

To the anonymous editor who has been working on this article: when you made an edit last week I converted your hyperlinks into proper scientific references. I was hoping you'd continue in that vein. Your expertise is much appreciated. JFW | T@lk 07:32, 8 Jun 2005 (UTC)

Dear JFW I stumbled across this page while exploring Google's Sarcoidosis rankings

I note your comments: "Okay, I've structured this. The link to the Marshall study was incorrect and this is not clinical practice anyway (how do you control vitamin D levels?) Instead of citing lots of original studies, I would recommend focussing on reviews to decrease the citation load."

I would have appreciated your contacting me before using my name in public in this way. My email is on all our peer-reviewed papers.

If you are looking for reviews, then I would suggest the following for an explanation of not only how you control the D metabolism, but also its effects on Th1 disease:- Marshall TG, Marshall FE: Sarcoidosis succumbs to antibiotics - implications for autoimmune disease. Autoimmunity Reviews,2004; 3(4):295-3001. Available from URL http://dx.doi.org/10.1016/j.autrev.2003.10.001 FullText at author website http://yarcrip.com/sarcoidosissuccumbs-preprint.htm

If you read Russian you might also cite a, more detailed, invited paper to a print journal:- Marshall TG, Fenter B, Marshall FE: Antibacterial Therapy Induces Remission in Sarcoidosis. Herald MKDTS 2004g; Volume III: Release 1. (The Journal of the Interregional Clinical-Diagnostic Center, Kazan, Invited paper, Special issue on Sarcoidosis. Published in Russian translation). ISSN: 1726-6149 Available from URL http://www.icdc.ru/home.nsf/ae6ba61f2370d2c3c3256f4800499282/7c4adb204d59034bc3256f660035e4ce?OpenDocument

Another citation to a print publication is Marshall TG, Marshall FE: Sarcoidosis succumbs to antibiotics - implications for autoimmune disease. Autoimmunity Reviews,2004; Suppl 2:55 (Abstracts of 4th International Congress on Autoimmunity)

I know that a lot of our work may seem counter-intuitive to a practioner, as it does require a fairly comprehensive understanding of molecular medicine to untangle the decades of poorly performed epidemiological studies upon which the myths which have perpetuated these idiopathic diseases are based.

Anyway, feel free to contact me at any time

Sincerely, Trevor — Preceding unsigned comment added by Trevmar (talk • contribs) 13:19, 16 June 2005

Including any research by Trevor Marshall is dangerous. I have this disease, and almost fell for his protocol. He is not a PhD, and his doctorate is in elctronic engineering. His protocol has never been published or reviewed. [[1]]

71.252.139.254 01:24, 13 September 2006 (UTC)Gnaget

I also removed the reference to autoimunity research foundation as them being a sponsor is irrelevant. Them being a sponsor only gives the impression of FDA acceptance of Marshall's protocol, when in fact there is none. 71.252.139.254 01:40, 13 September 2006 (UTC) Gnaget

I agree. I read with great worry the article about Trevor Marshall on Wikipedia, which seems to me has been written by just one or two people, to glorify the achievements of that man. To me, such contributions undermine the value of Wikipedia.

I have neither time nor nerve to argue with this man but many contributions on the net cast doubt on this person, most notably this [[2]] contribution by Peter Vanlandschoot. A less authoritative but very interesting website provides a compilation of uncertainties [[3]]. Savisha 08:40, 10 December 2006 (UTC)savisha

characterization of sarcoid

I removed the reference to sarcoid as an autoimmune disease. The reason is 1. the cause hasn't be exactly determined and 2.research seems to point towards sarcoid being caused by the immune system developing an abnormal response to an exposure - this may be viral, baterial, or environment apparently. Obviously, there is a genetic component which confers certain people with a higher risk of developing this response. If this is true, then, sarcoid is not an autoimmune diease because the body is not attacking its own tissues directly. Rather it is directing itself against a foreign antigen, but for some reason not clear to me, responds unusually and causes indirect damage to the hosts own tissues. Also the pathophys part is too narrow. It cites one article that is way out there compared to the vast majority of the literature on sarcoidosis. I'll likely revise it soon to more closely reflect more accept thoughts regarding pathophysiolgy and etiology. I'm not saying what is there is wrong, its just too focused and ignores the prevailing theories which have much more evidence to back them up. -sph — Preceding unsigned comment added by Sph.md (talk • contribs) 00:38, 24 July 2005

I believe at this point it is pretty well accepted in the medical community as being an autoimmune disorder. If research finds enough evidence that it is not, it will be changed, but it is best for WP to be on the heels of the research, and not leading it

71.252.139.254 01:51, 13 September 2006 (UTC) Gnaget

As a member of the medical community and someone who has done talks on the topic at conferences, I can tell you that you are wrong. Read any peer reviewed article on the pathophys of sarcoid; not one will call it an autoimmune disease. Please read my explaination above. -sph — Preceding unsigned comment added by Sph.md (talk • contribs) 22:45, 7 February 2007

As a reaction to this I would like to say there remains a lot of vagueness. Look at the wiki page of ReA:

ReactiveReactive arthritis (ReA) is an autoimmune condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger reactive arthritis.[1] It has symptoms similar to various other conditions collectively known as "arthritis," such as rheumatism. It is caused by another infection and is thus "reactive", i.e., dependent on the other condition. The "trigger" infection has often been cured or is in remission in chronic cases, thus making determination of the initial cause difficult. —Preceding unsigned comment added by 217.136.229.100 (talk) 14:25, 30 May 2008 (UTC)

If it is "pretty well accepted in the medical community as being an autoimmune disorder" then please provide a source or sources that state this opinion. Then someone can post the sources that support the external antigen suspicion/associations. —Preceding unsigned comment added by Broncko (talk • contribs) 09:02, 7 September 2010 (UTC)

sarcoidosis

hi, my husband, 51 yrs., recently diagnosed with sarcoid. the involvement in the bones and marrow is such that the current doctor says he has "poor prognosis factors" due to the extenrt of the diasease and that she thinks he is "doing quite well for the shape he is in". she also mentioned mayo clinic due to the extreme involvement in the lungs, spinal column etc. he works outside on road construction..... she has perscribed 80 mg prednisone for 1 wl, then 70 2nd week then 60 for the remainder of a six month period plus bactrim, plus calcium, vit d and fosomax..... no one will say what the "poor prognosis factor" is. i have a call in to see if the dr thinks we whould go to mayo...... is there any medical person out there that can help us????? where should i write so someone can look at his test results etc.... he recentl;y had a kidney stone rem,oved... that is what started all this the er dr said he had cancer!!! we have been to like 8 different Drs. getting this diagnosis - bone marrow biopsy beint the last one because there is so much involvement in the spine they were afraid to call it sarc

thanks, Deb...... dshupak@msn.com —Preceding unsigned comment added by 71.210.86.109 (talk) 19:17, 7 June 2006

Good day, Deb. I wish to point you towards Wikipedia:Medical disclaimer. While many Wikipedia writers are experts in their subject area, this is a publicly editable encyclopedia. As such, I recommend you discuss your husband's decision with a licensed medical doctor -- any person could post fictitious responses to you, and the information would be unreliable. I wish you and your husband the best. —Preceding unsigned comment added by 74.128.192.127 (talk) 20:28, 5 November 2006

Hello Deb,

I am not a medical professional but i've been dealing with Sarcoidosis for 10 years and worked in a Hospital for almost that long. I see 3 main issues to address in your article.

First, Mayo Clinic and The Cleveland Clinic Foundation are 2 of the best hospitals for treatment of Sarcoidosis and if there is a question a second opinion from a more qualified specialist is a good thing. Best to err on the side of caution.

Second, He is on what is called a taper down burst dose of prednisone. This is typical for controlling a Sarcoid flareup. Unfortunately the prednisone itself will tend to mask the symptoms so you will not really get a better idea of how he's really doing until he's on the lower doses.

Third, You mentioned Vitamin D as part of his treatment. That is to be expected with the involvement in the bones but Vitamin D in Sarcoidosis patients has been known to cause Hypercalcemia due to indications of false lows in patients with Sarcoidosis so his care should be supervised by a qualified physician. If you want to do some research on your own or get better input I would strongly urge you to sign up at Inspire.com most of us there have been dealing with this disease anywhere from 1 to 30 years and can give you very good input but remember there is no substitute for a qualified medical specialist. ( I did say specialist not physician) Good luck to you both. —Preceding unsigned comment added by 174.100.135.1 (talk) 03:56, 23 October 2010 (UTC)

Suggestions for the first paragraph

Can we add a layman's description to the first paragraph? I want to know what sarcoidosis is, but I don't know what a non-necrotising granuloma is. Also, shouldn't the cause be in the first paragraph as well? --65.91.102.204 16:26, 20 March 2007 (UTC)

I agree. We should add a Related Terms section that includes the definition of some of these medical terms. Otherwise we should review the article and create hyperlinks to the definition where these terms are used. 69.109.246.218 (talk) 18:05, 9 August 2008 (UTC)

NEJM

Review in NEJM (Tierstein worked with Siltzbach of Kveim test fame) JFW | T@lk 01:52, 29 November 2007 (UTC)

Sept 11/WTC references

I changed the wording in reference to the link between sarcoidosis and the WTC collapse. The page it references lists 2 cases that were "attributed" to dust inhalation, but from what I read in the citations not actually caused by the dust. The NY Times article states that the dust most likely impacted the time of death, but that the disease was present prior. I'm open to discussion and either making it an even lighter reference, or reverting if there is other evidence. Schu1321 (talk) 08:21, 29 May 2008 (UTC)

Pregnancy

I have created this section again, imho this deserves to have an own section or at least a place outside the Causes and pathophysiology section because the latter is too much speculative - and can expected to be as long as there is no definitive answer about the causes. Richiez (talk) 12:54, 11 June 2008 (UTC)

Bernie Mac

There is recent buzz about the highly likely possibility that this disease was the primary cause of death for comedian Bernie Mac. Hurricanefloyd (talk) 13:56, 9 August 2008 (UTC)

• The section Popular Culture has been deleted as it contained only one reference, a reference to Bernie Mac, that admitted "his death was not related to the disease." Bernie Mac died of complications of pneumonia, so his death is irrelevant to this article. In fact, the only connection between Bernie Mac and this article is the fact that he was diagnosed with sarcoidosis, but what encyclopedic value is that? I doubt there is consensus to create a listing of every famous person diagnosed with sarcoidosis. Sincerely, Stephen Eakin 72.187.72.217 (talk) 12:45, 11 August 2008 (UTC)

I would like to know if there was an

autopsy for Bernie Mac. I have had sarcoidosis for about 20 years. I took prendenson as treatment several times. I am ok now for about 3 years. But I see my lung specialist every 6 months and some times once a year.

He does the complite work up fo my lungs. I would like to know the results of the autopsy. Bernie Mac was a great man and very well liked. I think this is something that should have been done to help other that have sarcoidosis. —Preceding unsigned comment added by 24.125.204.20 (talk) 17:15, 2 October 2008

With all due respect, I disagree that Bernie Mac's death is irrelevant to this article or to any article/discussion about Sarcoidosis. Was his death related to Sarc? We don't know. But as a Sarcoidosis patient, I do know that pneumonia is especially dangerous to a person who sustained lung damage due to Sarc in the lungs. The lungs are a common organ attacked by Sarc. If Mr. Mac's lungs were damaged by the Sarc before he went into remission, then his lungs were already compromised before the pneumonia hit. If that is the case, it becomes a "Which came first?" scenario in my opinion. Thank you. Sad Sarc Queen (talk) 07:46, 6 March 2009 (UTC)

Bernie Mac did die from sarcoidosis. Check out his foundation page. The information is there - http://berniemacfoundation.org/ - Pneumonia is a complication of sarcoidosis, and I believe, led to his immediate death. I realize my opinion may be due to my own personal loss. My dad just died from sarc after contracting pneumonia and entering cardiac arrest. I pray more research is done on this disease and that major breakthroughs will come in the next few years. RIP papa (Mar 4, 2010) - written by MFS, 9:19pm est, May 13, 2010 Emme932 (talk) 01:25, 14 May 2010 (UTC)

Shouldn't There Be A Section Discussing The Difference Between Sarcoidosis and HIV?

Shouldn't there be a section discussing the differences between Sarcoidosis and HIV? When I first heard of this disease I wondered if doctors could mistake HIV for Sarcoidosis - in the situation where there was a rushed diagnosis. However, once I read about the circumstances under which Sarcoidosis thrives, it became clear to me these were diseases at 180 degress of each other:

http://www.thebody.com/Forums/AIDS/Infections/Archive/Miscellaneous/Q14878.html

It is possible that your sracoidosis may flare when your T cells are high (meaning your immunesystem is working better) and your viral load is not detectable. This is because the manifestations of sarcoidosis depend on a functioning immune system for expression. So as you continue to do well with your HIV, you may well need active oversight by a knowledgeable doctor for your sarcoidosis. With your current HIV status, it is highly unlikely that any clinical problem will be directly related to your HIV, so you should relax on that score.

69.109.246.218 (talk) 17:54, 9 August 2008 (UTC)

I would think it would be great see a page titled "The Great Mimicker" which could discuss the similarities of sarcoidosis with many of the diseases it emulates. - 7 July 2010 —Preceding unsigned comment added by 76.25.74.193 (talk) 23:47, 28 July 2010 (UTC)

Treatment Section

Should the quote be "As much as 70% of people do not require treatment..." The quote as it stands now "Between 30 and 70%..." is odd because either you require treatment or you don't, so there should be a firm number like X % of people with this disease require treatment. 68.42.71.39 (talk) 23:21, 10 August 2008 (UTC)Brad

it is faithfully copied form the mentioned source.. I wonder if it would be ok to add "(estimates do vary)" if the original source does not explicitly explain its meaning of 30-70%? Richiez (talk) 21:14, 20 September 2009 (UTC)

External link

I think that an important contribution to this discussion is the Foundation for Sarcoidosis Research. The Foundation for Sarcoidosis Research (FSR) is the United States' leading nonprofit organization dedicated to improving care for sarcoidosis patients and to finding a cure for this disease. Foundation for Sarcoidosis Research

They are active across the United States and have a growing presence in many areas both in the medical community and the patient community.

— Preceding unsigned comment added by Ubritsa (talk • contribs) 02:42, 31 March 2009

It is unclear how this would be useful for the reader. Not speaking about the organisation but their webpage. Richiez (talk) 11:46, 26 May 2010 (UTC)

Cancer

"The anergy may also be responsible for the increased risk of infections and cancer." This needs development. —Preceding unsigned comment added by 71.66.237.92 (talk) 21:12, 24 September 2009

Images needed

The following language

"Chest X-ray changes are divided into four stages

• Stage 1 bihilar lymphadenopathy
• Stage 2 bihilar lymphadenopathy and reticulonodular infiltrates
• Stage 3 bilateral pulmonary infiltrates
• Stage 4 fibrocystic sarcoidosis typically with upward hilar retraction, cystic & bullous changes"

is in medical language that would be more easily understood by providing an image for each stage. Perhaps the discussion should include CT images rather than or in addition to chest x-rays. In any event, this should be a priority. This would help a patient who is familiar with his or her own images to understand the severity of his or her disease. —Preceding unsigned comment added by 71.79.245.47 (talk) 16:15, 21 February 2010 (UTC)

Reference to broken DOI

A reference was recently added to this article using the Cite DOI template. The citation bot tried to expand the citation, but could not access the specified DOI. Please check that the DOI doi:10.1378 has been correctly entered. If the DOI is correct, it is possible that it has not yet been entered into the CrossRef database. Please complete the reference by hand here. The script that left this message was unable to track down the user who added the citation; it may be prudent to alert them to this message. Thanks, Citation bot 2 (talk) 04:17, 30 April 2010 (UTC)

I've replaced the errant reference (#46) with two new ones supporting the co-occurrence of sarcoidosis with cancer. Martin (Smith609 – Talk) 12:35, 2 May 2010 (UTC)

Systemic?

The first sentence describes it as a "systematic" disease. I assume that should be "systemic"? Systematic doesn't seem to make sense... —Preceding unsigned comment added by 76.208.70.201 (talk) 00:36, 26 May 2010 (UTC)

Agreed, although this appears to be fixed by now. Rytyho usa (talk) 22:56, 27 March 2013 (UTC)

Hutchinson's Disease

Is Sarcoidosis not also known as Hutchinson's disease? Can anyone confirm this and make the edit? Perhaps there is a Wiki article on the man himself (Hutchinson)? — Preceding unsigned comment added by 123.243.173.222 (talk) 16:52, 3 July 2011 (UTC)

Possibly, but without a reliable source, we mustn't state as such. --Redrose64 (talk) 18:48, 3 July 2011 (UTC)

Incidence or Prevalence?

Are the figures given under Epidemiology actually prevalence rather than incidence, as no time period is given? DeCaux (talk) 12:32, 5 November 2012 (UTC)

Current image

The image of lesions on the neck is somewhat vague as it looks a lot like plaque psoriasis (though the important detail here is that plaque psoriasis spreads to the face in the final stage of skin coverage, and rarely does anybody ever get to that). So a different picture depicting the sarcoidotal lesions as seen in Google Images would be more appropriate. — Preceding unsigned comment added by Adifeldman (talk • contribs) 05:05, 5 April 2013 (UTC)

Merge

Hello to all! I am proposing a merge from the following articles into the main sarcoidosis article:

• Annular sarcoidosis
• Erythrodermic sarcoidosis
• Ichthyosiform sarcoidosis
• Hypopigmented sarcoidosis
• Erythrodermic sarcoidosis
• Morpheaform sarcoidosis
• Mucosal sarcoidosis
• Papular sarcoid
• Scar sarcoid
• Subcutaneous sarcoidosis
• Ulcerative sarcoidosis

This is for the following reasons:

• These articles are very short in length (1-2 sentences) and have not been edited significantly in 3-4 years.
• This knowledge shouldn't be obscured from readers of sarcoidosis by virtue of being isolated in an obscure article of 1-2 lines.
• These topics may receive more attention by being mentioned in the main article.
• The articles, if needs be, could be re-expanded at a later date.

Kind Regards, LT90001 (talk) 13:01, 9 August 2013 (UTC)

• Support merge. As very short articles it would be much better to consolidate the knowledge in the larger Sarcoidosis article, so it is seen by more editors, and can be improved. Expansion to separate articles would be fine later if any sections reach a critical mass of article-worthy information. N2e (talk) 16:09, 9 August 2013 (UTC)
• Oppose This seems to be based on the idea that there is a WP:DEADLINE for people to expand articles about rare diseases. There is no deadline, and articles about rare diseases tend to get expanded when someone has a personal reason to care or when the article randomly appears in the news. We know from past experience that it is hard for new editors to figure out how to re-create an article from a redirect, and expansions are far more likely if you leave them as-is.
  These are actually independently notable diseases that do qualify for separate articles. For example, for the first in the list, Annual sarcoidosis, PMID 19663829 is a recent review on that specific disease and PMID 21677887 is a (free) paper discussing a new treatment for it. There are also other books available. IMO basic information should be included here, too, in the same way that we describe WP:SEEALSO entries, but the stand-alone articles should be left as they are. WhatamIdoing (talk) 15:56, 13 August 2013 (UTC)

Lancet review article, 2013

Particularly good on basic science. --Nbauman (talk) 07:17, 5 October 2013 (UTC)

Suggested additions, modifications and corrections

Wikipedia, talk, Sarcoidosis I found myself in disagreement with some of the content of the current article. I’ve supplied citations supporting the views I’ve expressed so that you can review them and come to a decision to either reject or accept the modifications I’ve indicated. If some articles are inconvenient to access, I may be able to supply them on request. I hope these suggested modifications will augment and improve the accuracy of the article. Yours truly, Jerome M Reich, MD, FCCP Reichje@isp.com

1. General: There is no better overview of the subject than Scadding JG, Mitchell DN. Sarcoidosis 1985 University Press, Cambridge ISBN 0 412 21760 0. Hutchinson’s contributions and citations can be found in this tome, e.g., Hutchinson J. Cases of Mortimer’s malady. Arch Surg, Lond. 1898;9:307-14.

2. Prognosis: Pulmonary fibrosis is most often residual, localized and clinically inconsequential. (Reich JM, Johnson RE. Course and prognosis of sarcoidosis in a nonreferral setting: analysis of 86 patients observed for ten years. Am J Med 1985;78:61-67). Mortality (actually, cumulative sarcoidosis fatality) in referral settings after adjustment for stage (still, the best available prognostic indicator) is 7.5-fold that in community settings (<1%) (Reich JM. Mortality of intrathoracic sarcoidosis in referral vs. population-based settings: influence of stage, ethnicity, and corticosteroid therapy. Chest 2002;121:32-39.)

3. Diagnosis: I disagreed with the “Halstedian” approach to diagnostic confirmation advanced in the article. See Scadding, above. We estimated a 99.95% positive predictive value for the clinical diagnosis of stage I disease. (Reich JM, Brouns MC, O’Connor EA, Edwards MJ. Mediastinoscopy in patients with presumptive stage I sarcoidosis: a risk/benefit, cost/benefit analysis. Chest 1998;113(1):147-53). The joint guideline article you cited (67), with which I agree, cited a similar clinical PPV. The PPV for stage II is nearly as high.

4. Treatment absent compelling symptoms: Ref 67 cites progression, not duration of pulmonary involvement as the treatment indication. There is persuasive evidence that suppression of the early immune response interferes with its resolution, thereby worsening its outcome. (Reich JM. Mortality of intrathoracic sarcoidosis in referral vs. population-based settings: influence of stage, ethnicity, and corticosteroid therapy. Chest 2002;121:32-39. Reich JM. Adverse long-term effect of corticosteroid therapy in recent-onset sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2003;20(3):227-34. Reich JM. Con: The treatment of the granulomatous response is beneficial in acute sarcoidosis [Debate]. Respir Med 2010;104:1778-81 and 1782-83. [Pro: Culver DA. Complete debate: 1775-83.]

5. Neoplasia: There is persuasive evidence that intratumoral, local, regional and systemic granulomatous responses (“sarcoidosis”) to neoplasia represent a continuum. (Reich JM, Mullooly JP, Johnson RE. Linkage analysis of malignancy-associated sarcoidosis. Chest 1995;107:605-13. Reich JM. Neoplasia in the etiology of sarcoidosis. Eur J Intern Med 2006;17(2):81-87. Reich JM. Neoplasia in the etiology of sarcoidosis [Letter]. Amer J Med 2013;126(1):e17. doi: 10.1016/j.amjmed.2012.05.031 A systemic granulomatous response to neoplasia risks the possibility of being mistaken for metastatic carcinoma. Sarcoidosis does not simulate cancer. Isolated bilateral hilar adenopathy is easily distinguished from anterior mediastinal adenopathy, the latter being the typical appearance of intrathoracic lymphoma.

6. Epidemiology: Your uncited incidence figure seems too high. Constraints, data and incidence classification are furnished in: Reich JM. A Critical analysis of sarcoidosis incidence assessment [Commentary]. Multidiscip Respir Med 2013, 8:57. DOI: 10.1186/10.1186/2049-6958-8-57

7. Other causes: I challenged these causal inferences on the basis of their methodological flaws. Reich JM. Shortfalls in imputing sarcoidosis to occupational exposures [Editorial]. Amer J Ind Med. 2013;.56:496-500. doi: 10.1002/ajim.22083.

8. Fundamental nature: I furnished a view of sarcoidosis—an etiologically heterogeneous, systemic granulomatous default response, attributable to inefficient cellular immune processing, most often of unknown cause—that accounts for the spectrum of otherwise enigmatic features: elusiveness of “the” causal agent; the “immune paradox”; its development in response to a variety of identified antigenic sources; the vulnerability to its development imposed by diverse cellular immunological deficiencies; the seemingly paradoxical (i.e., favorable) relationship to the intensity of the cellular response; the nature of the Kveim response; and the adverse impact of immunosuppression in recent-onset disease. (Reich JM. On the nature of sarcoidosis. Eur J Intern Med; 2012 (23):105-109. 10.1016/j.ejim.2011.09.011)

9. Auscultation: One of the striking findings is the absence of adventitious breath sounds in sarcoidosis even in the presence of extensive pulmonary shadowing, a finding that helps distinguish it from other causes of diffuse pulmonary shadowing.

I hope you find this information useful.

Reichje (talk) 16:54, 28 November 2013 (UTC)

NEJM

doi:10.1056/NEJMra2101555 JFW | T@lk 13:22, 13 September 2021 (UTC)