Louis E. Siltzbach

Sarcoidosis, Another Disease Associated with Serologic Evidence for Herpes-like Virus Infection

Abstract The herpes-like virus (HLV, and also EBV), first detected in lymphoid cell cultures derived from Burkitt tumor, has been suggested as the etiologic agent of infectious mononucleosis, and has been suspected of playing a part in the pathogenesis of African Burkitt lymphoma and carcinoma of the posterior nasal space. Most of the evidence for these associations between virus and disease has come from seroepidemiologic data. Our study of serums from 131 patients with sarcoidosis indicates that all have antibody to HLV and in 79 per cent the titers were 1:640 or higher. This contrasts with a 76 per cent prevalence of antibody in a control group with considerably lower titers. Sarcoidosis, therefore, is the fourth disease to be linked serologically with HLV infection. Since four diseases have now been associated with infection by the same virus, any conclusions regarding the pathogenic role of HLV in any given condition must be made cautiously.

Childhood sarcoidosis--a study of 18 patients.

Abstract Of 18 children with a tissue diagnosis of sarcoidosis 11 were symptomatic; seven were asymptomatic, but on routine x-ray study exhibited hilar adenopathy often combined with pulmonary mottling. The children with symptoms were younger, had more extensive disease and a longer and more complicated course of illness than those who were asymptomatic; they frequently required glucocorticosteroids or chloroquine. The asymptomatic children fared better than those with symptoms. Asymptomatic sarcoidosis in children is more frequent than is currently recognized but its true prevalence is likely to remain unknown, since mass chest x-ray surveys and routine chest radiography are not systematically pursued in tuberculin-negative children. Earlier recognition of sarcoidosis in children may prevent some of the complications of this disorder such as blindness and pulmonary insufficiency.

Changes in rheumatoid factor activity during the course of sarcoidosis

Abstract Among sixty-four patients with a tissue-confirmed diagnosis of sarcoidosis studied for the presence of rheumatoid factor in their serum an over-all frequency of 38 per cent was found on initial testing. The presence of rheumatoid factor was unrelated to the presence or absence of joint symptoms. Rheumatoid factor was more prevalent in active disease processes than in inactive disease, and in patients with later stages of pulmonary involvement than with hilar node enlargement alone. Patients who exhibited rheumatoid factor were ill with sarcoidosis approximately twice as long on the average as those who did not. Rheumatoid factor was found nearly twice as often in female subjects as in male subjects. The presence of rheumatoid factor initially was of little prognostic significance, but disappearance or reduction of rheumatoid factor titers upon later retesting was associated with an improving clinical course. Conversely, appearance of rheumatoid factor for the first time or increase in titer on retesting was associated with continued disease activity and with a relatively poorer clinical outcome. The tanned sheep cell test was considerably more sensitive than latex tests in detecting rheumatoid factor activity in sarcoidosis.

Serologic factors in idiopathic diffuse interstitial pulmonary fibrosis

Abstract In nineteen patients with idiopathic diffuse interstitial pulmonary fibrosis, the serum of five (27 per cent) revealed latex-fixing macroglobulins. In four there were accompanying transient arthritic manifestations which were not readily classifiable. A comparable incidence of latex-fixing reactivity has been demonstrated in the serum of patients not afflicted with rheumatoid arthritis suggesting that this finding is not specific for any one disease. It is proposed that consideration of the diagnosis of rheumatoid lung be reserved for the rare combination of pulmonary fibrosis and unequivocal rheumatoid arthritis.

Sarcoidosis of the Skull

OSSEOUS lesions occur in a minority of patients with sarcoidosis. When these lesions do occur, they are almost always limited to the bones of the hands and feet. Sarcoidosis of the skull is one of the rarest manifestations of this systemic disease. We could find only 2 other reported cases of skull localization confirmed by bone biopsy.1 , 2 This communication describes a patient under observation for chronic generalized sarcoidosis who exhibited two slowly growing, firm protuberances of the forehead, each attaining walnut size. When radiologic examination of the skull revealed punched-out areas in the frontal bone associated with the swellings, problems .xa0.xa0.

Sarcoidosis of the uterus

Abstract 1. 1. A case of generalized sarcoidosis with asymptomatic uterine involvement is reported. Characteristic epithelioid granulomas were found in the endometrium and myometrium of a uterus removed by vaginal hysterectomy. 2. 2. Although sarcoidosis is a systemic affection with multiorgan involvement, localization in the uterus is extremely rare. A survey of the literature discloses reports of only five previous instances of uterine sarcoidosis. 3. 3. Though in three cases curettage was performed for abnormal bleeding, it seems unlikely that the sarcoid uterine granulomas were responsible for the symptoms. 4. 4. The finding of tuberclelike granulomas in the endometrium or myometrium should alert one to the possibility of sarcoidosis. The diagnostic criteria of this disease are described. Differentiation must be made from tuberculous and foreign body reactions.