Sarcoidosis in World Trade Center Rescue Workers Presenting With Rheumatologic Manifestations

Abstract

The health consequences of the World Trade Center collapse are unknown, but likely to be significant and may take years to fully appreciate. Sarcoidosis is a multisystem inflammatory disorder of unknown etiology characterized pathologically by noncaseating granulomas. Inciting events, such as infectious agents or possible environmental exposures, have been postulated as the source of antigen exposure initiating an inflammatory cascade. We describe 2 cases of sarcoidosis in rescue workers with significant exposure from the World Trade Center collapse, who presented with extrapulmonary rheumatologic manifestations. Our first case involved a 33-year-old white New York City man detective found to have sarcoidosis following an evaluation of diffuse joint pain. The second case involved a 40-year-old African American man, New York City officer, who presented with uveitis, and was subsequently diagnosed with sarcoidosis. These 2 cases extend the spectrum of disorders resulting from the World Trade Center disaster and illustrate the need for clinicians to be aware of the diverse presentations of sarcoidosis in this patient population.

Health effects of World Trade Center (WTC) Dust: An unprecedented disaster with inadequate risk management

“…Bowers et al (2010) examined health consequences of the WTC collapse in terms of incident sarcoidosis, a multisystem inflammatory disorder of unknown etiology characterized pathologically by non-caseating granulomas. They described two cases of sarcoidosis in rescue workers with significant exposure from the WTC collapse and who presented with extrapulmonary rheumatologic manifestations.…”

“Sarcoid like” granulomatous pulmonary disease in World Trade Center disaster responders

“…The lay press has also reported four case fatalities due to interstitial pulmonary fibrosis, sarcoidosis (cardiopulmonary involvement) and granulomatous pneumonitis in non-FDNY subjects who were exposed to the WTC dust [Izbicki et al, 2007]. Additionally, sarcoidosis with extrapulmonary rheumatologic manifestations was also reported in two New York City police officers following exposure to pollutants during their rescue operations at Ground zero [Bowers et al, 2010].…”

Occupational causes of sarcoidosis

“…They stratified individuals in their cohort based on self-reported dust cloud exposures and observed that more intensive rescue and recovery activities were associated with increased disease risk [10]. Some such cases of World Trade Center sarcoidosis-like illness demonstrate extensive, multiorgan involvement [11]. Additionally, Crowley and coworkers calculated an extraordinarily high annual incidence rate of 229 sarcoidosis cases per 100,000 person years, based on record review of nearly 20,000 individuals in their World Trade Center medical surveillance program [12], providing independent confirmation of what had previously been published in a cohort of New York City firefighters and emergency response personnel.…”