Immunologic Studies in Patients With Sarcoidosis and Cryptococcosis

Belcher, Richard W.

doi:10.1001/archderm.1975.01630180039001

Cited by 11 publications

(3 citation statements)

References 31 publications

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“…In this study, as well as that reported by Prevel et al, peripheral blood CD4 lymphocytopenia was not an independent risk factor [30,85]. The alteration of qualitative CD4 T-cell function could be involved in the pathophysiology, but T-cell dysfunction in sarcoidosis is poorly understood [85,96]. An altered CD4 T-cell-macrophage crosstalk has experimentally been demonstrated to be involved via the decreased macrophage ability to contain Cryptococcus spp.…”

Section: Are Anti-infectious Mechanisms Associated With Sarcoidosis I...supporting

confidence: 74%

Infectious Complications of Pulmonary Sarcoidosis

Valeyre,

Bernaudin,

Brauner

et al. 2024

JCM

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In this review, the infectious complications observed in sarcoidosis are considered from a practical point of view to help the clinician not to overlook them in a difficult context, as pulmonary sarcoidosis makes the recognition of superinfections more difficult. An increased incidence of community-acquired pneumonia and of opportunistic pneumonia has been reported, especially in immunosuppressed patients. Pulmonary destructive lesions of advanced sarcoidosis increase the incidence of chronic pulmonary aspergillosis and infection by other agents. Screening and treatment of latent tuberculosis infection are crucial to prevent severe tuberculosis. Severity in COVID-19 appears to be increased by comorbidities rather than by sarcoidosis per se. The diagnosis of infectious complications can be challenging and should be considered as a potential differential diagnosis when the exacerbation of sarcoidosis is suspected. These complications not only increase the need for hospitalizations, but also increase the risk of death. This aspect must be carefully considered when assessing the overall health burden associated with sarcoidosis. The impact of immune dysregulation on infectious risk is unclear except in exceptional cases. In the absence of evidence-based studies on immunosuppressants in the specific context of pulmonary sarcoidosis, it is recommended to apply guidelines used in areas outside sarcoidosis. Preventive measures are essential, beginning with an appropriate use of immunosuppressants and the avoidance of unjustified treatments and doses. This approach should take into account the risk of tuberculosis, especially in highly endemic countries. Additionally, parallel emphasis should be placed on vaccinations, especially against COVID-19.

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Section: Are Anti-infectious Mechanisms Associated With Sarcoidosis I...supporting

confidence: 74%

Infectious Complications of Pulmonary Sarcoidosis

Valeyre,

Bernaudin,

Brauner

et al. 2024

JCM

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“…This is higher than among the white population, and the figures are comparable with incidence rates in London. 2 Belcher et al, 3 in a study of two cases of sarcoidosis complicated by cryptococcosis, state that up to the time of writing (June 1975) at least 25 cases of this disease combination had been reported. 3 This indicates that it may be a worldwide and not excessively rare association.…”

Section: Discussionmentioning

confidence: 99%

“…It was not possible to define the precise nature of the defect in cell mediated immunity but it was shown that the other host defence mechanisms (antibody production and neutrophil function) were normal. 3 The most common sites of cryptococcal infection in sarcoid patients are osteolytic bone lesions, pulmonary infection, and localised skin lesions, with a non-lethal course. Patients with C neoformans in the cerebrospinal fluid have a high mortality.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningitis in an HIV negative patient with systemic sarcoidosis.

Botha

Wessels

1999

J Clin Pathol

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A case of Cryptococcus neoformans meningitis is described in an HIV negative patient with undiagnosed systemic sarcoidosis. The patient presented with signs of meningitis together with generalised lymphadenopathy and hepatosplenomegaly. Cryptococcal meningitis was diagnosed on lumbar puncture. She was treated with intravenous amphotericin B but died within two weeks of admission. Necropsy revealed lesions in the lungs, liver, spleen, lymph nodes, small intestine, and bone marrow consistent with sarcoidosis. Microscopically the lesions contained non-caseating epithelioid cell granulomas typical of sarcoidosis. No Schaumann or Hamazaki-Wesenberg bodies were identified. Cryptococcus neoformans meningitis is generally associated with immunosuppressive disorders. As T cell abnormalities have been described in sarcoidosis, this could have been a case of opportunistic infection. Although rare, sarcoidosis merits consideration in patients with cryptococcal disease in the absence of HIV infection. (J Clin Pathol 1999;52:928-930)

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