Jan Kus

Respiratory system involvement in inflammatory bowel diseases

Inflammatory bowel diseases are systemic disorders that can manifest in any location. The problem of respiratory system involvement is very important form clinical point of view. In the article we try to systematize the current knowledge on this topic.

Neurological signs in patients with sarcoidosis - is it neurosarcoidosis?

Introduction: The majority of patients with sarcoidosis are under pulmonologists care. The proper diagnostic work-up involves not only the respiratory system. Assessment of extrapulmonary organ involvement is an important element not only at the time of the diagnosis, but also during the further follow-up. Neurosarcoidosis is potentially dangerous and affects the prognosis of the disease. Aim: To assess the prevalence of neurological symptoms in patients with pulmonary sarcoidosis and analysis of causes. Method: Retrospective analysis of database of patients hospitalized in the 1st Department of Lung Diseases between January 2011 and December 2016, with the diagnosis of pulmonary sarcoidosis in whom magnetic resonance imaging (MRI) of nervous system was performed because of neurological symptoms. The diagnosis of neurosarcoidosis was made according to Zaijcek9s criteria. Results: 589 patients with pulmonary sarcoidosis, stage I-IV, were identified. 32 (5.4%) of them with neurological symptoms (24 men and 8 women; mean age 43.8±11.2) underwent imaging studies of the nervous system depending on the symptoms: 25 MRI of the brain and 9 MRI of the spinal cord. Finally, 4/32 (12.5%) of patients were diagnosed with neurosarcoidosis Conclusions: Neurological symptoms in patients with pulmonary sarcoidosis are rare and in most cases are assessed as unrelated to neurosarcoidosis.

Tuberculin skin test or interferon gamma release assay - How to detect latent tuberculosis infection in sarcoidosis patients?

Introduction: Tuberculin skin test (TST) is one of the test recommended in initial evaluation of patients suspected for sarcoidosis and most patients have negative TST results. At present, an alterative to TST are the tests based on the measurement of interferon gamma release by sensitized T lymphocytes in response to stimulation by antigens specific for M.tuberculosis (IGRAs). In many countries IGRAs replaced TST for detection of the latent tuberculosis infection (LTBI). The role of IGRAs in sarcoidosis patients is still unknown. Object and rationale: The aim of this study was a head to head comparison between TST and one of IGRAs – Quantiferon TB Gold in Tube (QFT) and to determine which of them is better to detect LTBI in sarcoidosis patients. Material and method: 151 patients, mean age 38.3±10.3, treatment naive, with newly diagnosed pulmonary sarcoidosis were included in the study. According to the Polish recommendation, TST ≥10 mm was considered positive. Concordance between TST and QFT was assess using kappa (κ) coefficient. Results: TST was positive in 16/151 (10.5%) and QFT was positive in 7/151 (4.6%). There was no concordance between TST and QFT (κ -0.07). All sarcoidosis patients with positive TST had negative QFT. All of QFT positive had negative TST. Conclusion: Positive IGRAs among TST negative patients indicate, that skin reactivity to tuberculin is not parallel to ex vivo peripheral blood lymphocytes response to mycobacterial antigens. QFT is better than TST for detection of LTBI in sarcoidosis patients. Positive TST results in sarcoidosis patients are not connected with LTBI, as assessed by QFT.