Sarcoidosis and berylliosis

Thomas Geiser Universitätsklinik fuer Pneumologie Inselspital 3010 Bern Switzerland [email protected]

AIMS

• Update on etiology and pathophysiology of sarcoidosis • What are the diagnostic procedures in suspected sarcoidosis • Therapeutic options in sarcoidosis • Update and overview on berylliosis

SUMMARY

Sarcoidosis is a multiorgan disease with unknown origin [1]. It is characterised by the formation of immune granulomas in various organs. Diagnosis is based on the clinical and radiological presentation and histology. Implementation of endobronchial ultrasound-guided bronchoscopy considerably improved histological diagnosis in the lung and mediastinal/hilar lymph nodes. Treatment depends on the clinical presentation and consists of immunomodulatory drugs with corticosteroids as first line therapy (2,3). Chronic beryllium disease is an important differential diagnosis that needs to be considered in patients with (occupational) exposure to beryllium [4,5].

REFERENCES

- Series «sarcoidosis from bench to bedside» (edited by V. Cottin and J. Müller-Quernheim). Eur Resp J 2012 - Sarcoidosis. Valeyre et al, Lancet 2014 383(9923):1155-67. - Pulmonary Sarcoidosis. Valeyre et al, Clin Chest Med 2015;36:631-641 - ATS Statement : Diagnosis and Management of beryllium sensitivity and chronic beryllium disease. Balmes JR et al, AJRCCM 190:10;e34-e59, 2014 - Sarcoidosis and chronic beryllium disease:Similarities and Differences. Mayer et al, Sem Resp Crit Care Med 35:3;316-329, 2014.

FACULTY DISCLOSURES

None

EVALUATION

Please provide 3-5 multiple choice questions AND their answers

1) Which of the following statements on sarcoidosis is correct a) Sarcoidosis is an infectious disease b) Incidence is about 200/100’000/year c) Peak in elderly people d) Th1 driven immunological disease

Answer D

2) Diagnostic procedure usually consists of the following examinations except a) Pulmonary function tests b) Serum levels of ACE (angioconverting enzyme) c) Bronchoscopy with BAL, TBB and EBUS guided biopsies d) Chest X-ray or CT scan

Answer B

3) In the following situations treatment with corticosteroids is indicated except a) dyspnea and cough in stage II sarcoidosis b) Löfgren syndrome c) Hypercalcemia d) Sarcoid-related uveitis

Answer B

4) Chronic beryllium disease is diagnosed by a) clearly different histological pattern than sarcoidosis b) typical reticular bibasilar pattern on CT scan with consolidations c) Clinical presentation, history of exposure to beryllium with positive beryllium lymphocytic proliferation test, granuloma formation d) Lymphocytic alveolitis with a CD4/CD8 ratio > 4 in BAL

Answer C