       Document 0194
 DOCN  M9620194
 TI    Pulmonary sarcoidosis: a mimic of respiratory infection.
 DT    9602
 AU    Blackmon GM; Raghu G; Department of Pulmonary and Critical Care
       Medicine, University of; Washington Medical Center, Seattle 98195, USA.
 SO    Semin Respir Infect. 1995 Sep;10(3):176-86. Unique Identifier : AIDSLINE
       MED/96087953
 AB    Sarcoidosis is an idiopathic multisystem disorder with several clinical
       and roentgenographic features suggestive of respiratory infection. In
       the absence of infection, it is characterized by the microscopic
       presence of noncaseating epithelioid granuloma in affected tissues. When
       present, constitutional symptoms, fever, coughing, and exertional
       dyspnea usually develop insidiously, although occasionally Lofgren's
       syndrome--the triad of bilateral hilar adenopathy, erythema nodosum and
       polyarticular arthritis--may herald the onset of acute disease.
       Pulmonary involvement is the roentgenographic hallmark of sarcoidosis;
       bilateral hilar adenopathy is the most common manifestation. However,
       parenchymal infiltrates and pleural effusion may occur. Although
       numerous bacterial and fungal organisms may mimic the clinical and
       roentgenographic features of sarcoidosis, tuberculosis and fungal
       infections associated with granulomatous inflammation are the infectious
       processes most apt to cause diagnostic confusion. Several diagnostic
       clues are available to the clinician confronted with the consideration
       of sarcoidosis. Roentgenographic staging of the disorder (stage 0,
       normal radiograph; stage I, isolated bilateral hilar adenopathy; stage
       II, hilar adenopathy and parenchymal involvement; stage III, isolated
       parenchymal involvement; and stage IV, parenchymal fibrosis) provides a
       framework on which a differential diagnosis of likely infectious agents
       may be constructed and a history of travel to regions of endemic fungal
       infection may further narrow the differential diagnosis. An unexplained
       exudative lymphocytic pleural effusion or CD-4 lymphocyte predominance
       in bronchoalveolar lavage (BAL) fluid may also suggest a diagnosis of
       sarcoidosis. However, the definitive diagnosis of sarcoidosis is
       dependent upon the histological demonstration of noncaseating granuloma
       and the exclusion of infection in the appropriate clinical and
       roentgenographic setting.
 DE    Adult  AIDS-Related Opportunistic Infections/DIAGNOSIS  Diagnosis,
       Differential  Female  Human  Lung/RADIOGRAPHY  Lung Diseases,
       Fungal/DIAGNOSIS  Male  Respiratory Tract Infections/*DIAGNOSIS
       Sarcoidosis, Pulmonary/*DIAGNOSIS/EPIDEMIOLOGY  Tuberculosis,
       Pulmonary/DIAGNOSIS  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

