&lt;i&gt;Propionibacterium acnes&lt;/i&gt;-associated Sarcoidosis Possibly Initially Triggered by Interferon-alpha Therapy

Sawahata, Michiru; Fujiki, Yasumaro; Nakano, Naomi; Ohtsuki, Mamitaro; Yamaguchi, Tetsuo; Uchida, Keiji; Eishi, Yoshinobu; Suzuki, Takuji; Hagiwara, Koichi; Bando, Masashi

doi:10.2169/internalmedicine.5281-20

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…The assumed pathogenesis of sarcoidosis caused by C. acnes is as follows: 1) commensal extracellular C. acnes causes asymptomatic intracellular infection. 2) latent C. acnes can be reactivated and proliferate intracellularly, which may be triggered by certain host-or drug-induced conditions (7,(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Sarcoidosis Which Occurred Four Years after Successful Treatment of Cutaneous Sarcoidosis with Minocycline

Kawano,

Motokawa,

Eishi

et al. 2024

Intern. Med.

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A 67-year-old woman was admitted to our hospital because of a complete right bundle branch block. She had been treated with minocycline for skin sarcoidosis and her symptoms had ameliorated four years previously. Gallium scintigraphy revealed an abnormal uptake in the heart but not in the skin or lungs. She was diagnosed with cardiac sarcoidosis, although an endomyocardial biopsy could not detect any sarcoid lesions. Immunohistochemical staining for Cutibacterium acnes was positive for granulomas of the skin lesions which had been previously biopsied. One year after starting the administration of steroids, her condition improved.

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Section: Discussionmentioning

confidence: 99%

Cardiac Sarcoidosis Which Occurred Four Years after Successful Treatment of Cutaneous Sarcoidosis with Minocycline

Kawano,

Motokawa,

Eishi

et al. 2024

Intern. Med.

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“…Localization of the immunohistochemical signals to C. acnes in sarcoid granulomas is shown in Figure 1 . Numerous case reports have described C. acnes detection in the granulomas of patients with pulmonary sarcoidosis [ 22 , 23 , 24 , 25 ], cutaneous sarcoidosis [ 26 , 27 , 28 , 29 , 30 , 31 ], nasal sarcoidosis [ 32 ], and neurosarcoidosis [ 33 , 34 ]. The term “ C. acnes -associated sarcoidosis” is applied to cases in which C. acnes is detected in granulomas via immunohistochemistry using the PAB antibody [ 35 ].…”

Section: C Acnes In Sarcoid Granulomasmentioning

confidence: 99%

“…The first prerequisite is latent infection by cell-wall-deficient C. acnes , which occurs not only in macrophages and vascular endothelial cells but also in epithelial and mesenchymal cells [ 76 , 77 , 78 ]. The onset of sarcoidosis is triggered by reactivation of latent C. acnes , which may be caused by host-related conditions such as physical or mental stress [ 79 ] or drug-induced conditions [ 80 ] such as the administration of interferons [ 25 ] and tumor necrosis factor-alpha antagonists [ 23 ]. The most critical cause of sarcoidosis is the host factor represented by Th1 hypersensitivity to the intracellular proliferation of latent C. acnes .…”

Section: Endogenous Hypersensitivity Infection Caused By C ...mentioning

confidence: 99%

Potential Association of Cutibacterium acnes with Sarcoidosis as an Endogenous Hypersensitivity Infection

Eishi

2023

Microorganisms

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The immunohistochemical detection of Cutibacterium acnes in sarcoid granulomas suggests its potential role in granuloma formation. C. acnes is the sole microorganism ever isolated from sarcoid lesions. Histopathologic analysis of some sarcoid lymph nodes reveals latent infection and intracellular proliferation of cell-wall-deficient C. acnes followed by insoluble immune-complex formation. Activation of T helper type 1 (Th1) immune responses by C. acnes is generally higher in sarcoidosis patients than in healthy individuals. Pulmonary granulomatosis caused by an experimental adjuvant-induced allergic immune response to C. acnes is preventable by antimicrobials, suggesting that the allergic reaction targets C. acnes commensal in the lungs. C. acnes is the most common bacterium detected intracellularly in human peripheral lungs and mediastinal lymph nodes. Some sarcoidosis patients have increased amounts of C. acnes-derived circulating immune complexes, which suggests the proliferation of C. acnes in affected organs. In predisposed individuals with hypersensitive Th1 immune responses to C. acnes, granulomas may form to confine the intracellular proliferation of latent C. acnes triggered by certain host-related or drug-induced conditions. Current clinical trials in patients with cardiac sarcoidosis are evaluating combined treatment with steroids and antimicrobials during active disease with continued antimicrobial therapy while tapering off steroids after the disease subsides.

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“…Many case reports with P. acnes detected in granulomas, including pulmonary sarcoidosis [ 54 , 55 ], cutaneous sarcoidosis [ 56 , 57 , 58 , 59 , 60 , 61 , 62 ], nasal sarcoidosis [ 63 ], and neurosarcoidosis [ 64 , 65 ], have been published. These cases in which P. acnes was identified in granulomas by IHC with the PAB antibody were recently termed P. acnes -associated sarcoidosis [ 55 , 64 , 65 , 66 , 67 , 68 ].…”

Section: M Tuberculosis and P Acnesmentioning

confidence: 99%

Immunohistochemical Detection of Potential Microbial Antigens in Granulomas in the Diagnosis of Sarcoidosis

Yamaguchi

Costabel

McDowell

et al. 2021

JCM

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Sarcoidosis may have more than a single causative agent, including infectious and non-infectious agents. Among the potential infectious causes of sarcoidosis, Mycobacterium tuberculosis and Propionibacterium acnes are the most likely microorganisms. Potential latent infection by both microorganisms complicates the findings of molecular and immunologic studies. Immune responses to potential infectious agents of sarcoidosis should be considered together with the microorganisms detected in sarcoid granulomas, because immunologic reactivities to infectious agents reflect current and past infection, including latent infection unrelated to the cause of the granuloma formation. Histopathologic data more readily support P. acnes as a cause of sarcoidosis compared with M. tuberculosis, suggesting that normally symbiotic P. acnes leads to granuloma formation in some predisposed individuals with Th1 hypersensitivity against intracellular proliferation of latent P. acnes, which may be triggered by certain host or drug-induced conditions. Detection of bacterial nucleic acids in granulomas does not necessarily indicate co-localization of the bacterial proteins in the granulomas. In the histopathologic diagnosis of sarcoidosis, M. tuberculosis-associated and P. acnes-associated sarcoidosis will possibly be differentiated in some patients by immunohistochemistry with appropriate antibodies that specifically react with mycobacterial and propionibacterial antigens, respectively, for each etiology-based diagnosis and potential antimicrobial intervention against sarcoidosis.

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<i>Propionibacterium acnes</i>-associated Sarcoidosis Possibly Initially Triggered by Interferon-alpha Therapy

Cited by 5 publications

References 9 publications

Cardiac Sarcoidosis Which Occurred Four Years after Successful Treatment of Cutaneous Sarcoidosis with Minocycline

Cardiac Sarcoidosis Which Occurred Four Years after Successful Treatment of Cutaneous Sarcoidosis with Minocycline

Potential Association of Cutibacterium acnes with Sarcoidosis as an Endogenous Hypersensitivity Infection

Immunohistochemical Detection of Potential Microbial Antigens in Granulomas in the Diagnosis of Sarcoidosis

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