Sarcoidosis: Lung Biopsy in Certain Cases May Help Control Complications

It is important to perform a lung biopsy when a change in chest X-ray is seen during pulmonary sarcoidosis monitoring, according to Japanese scientists in the study “Multicentric Castleman’s disease developing during follow-up of sarcoidosis.”

The biospy could rule out or lead to appropriate treatment of the rare multicentric Castleman’s disease (MCD).

The study recently published in Respirology Case Reports presented the case of a 60-year-old woman who did not express issues or concerns about her medical, family or smoking history. During her health exam doctors identified an enlargement in the lymph nodes (bilateral hilar lymphadenopathy) of her lung via a chest X-ray. Following a lung biopsy, the woman was diagnosed with stage 2 pulmonary sarcoidosis.

The shadow detected on her chest X-ray, which corresponded to a lymph node enlargement, disappeared without treatment. Eight years later, however, other shadows were seen on her chest X-ray and a second lung biopsy was performed. This time, the woman was diagnosed with pulmonary sarcoidosis complicated by MCD.

MCD is characterized by a hyperactive immune system. Excessive levels of pro-inflammatory chemicals (cytokines) are released and immune B- and T-cells proliferate leading to multiple organ system dysfunction.

The researchers reported that the patient was taking steroids to treat her MCD.

“It is important to differentiate the disease in order to initiate appropriate treatment,” wrote Dr. Tetsuro Sawata, of the Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University in Tochigi, Japan, and colleagues in the article. “Pulmonary sarcoidosis tends to react well to steroid treatment.”

Sarcoidosis can be associated with many diseases. Malignant lymphoma is one of them and has been reported as a complication of sarcoidosis in previous studies. MCD has rarely been associated with sarcoidosis. Only two other cases have been reported and the relationship between the two diseases is not fully understood.

Researchers concluded: “It  is important to proceed with testing via thoracoscopic lung biopsy to rule out the rare possibility of complication with MCD.”