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Sarcoidosis

Aggressive lung sarcoidosis

11/16/2007

Question:

i almost have total food intolerance. after most food is digested 12 to 48 hrs later my symtoms get worse. i have contriction throughout my body whitch causes sob because ribcage cant expand enough. all joints ache and crack and tendons tightens and pop. my lungs nodules have increased to 12 and some have grown. all my blood work comes back nearly perfect which doesnt make sense since i continue to get worse. had 2 nodules removed from lung and was decided it may be sarcoid but not 100% sure. steroids arent stopping the progression and i cant tolerate a high dose. where should i go for help? should i treat with antibiotics?

Answer:

Dear Sir/Madam-

Allergies to foods do not commonly cause granulomas (sarcoidosis-like) in the lung. Thus, it is unlikely that the food allergy explains your lung disease. However, allergies to inhaled substances (there are many of these), can cause granulomatous lung nodules. This disease is called hypersensitivity pneumonitis (HSP). Usually there is some identifiable exposure that triggers HSP and the lung tissue samples are a bit different than what is seen in sarcoidosis. Given your history of allergies, I would suggest that your doctors consider the possibility of HSP.

If you do have an allergic cause, you would be advised to avoid the exposure that is causing it. If you are found to have sarcoidosis, through the process of eliminating all other possibilities, you may benefit from a "steroid-sparing agent", such as methotrexate, to control your lung disease. There is not a well-established infectious cause of sarcoidosis reported in a reliable medical publication, but you can find some interesting theories if you search the "web". Although some unpublished reports (at least not published in a reliable medical journal) advocate the use of antibiotics, it should be noted that some patients with sarcoidosis get better without treatment and some antibiotics have anti-inflammatory actions (sort of like steroids). Thus, it is hard to know if the anecdotal reports of successful treatment of sarcoidosis with antibiotics are legitimate. Furthermore, antibiotics can cause adverse side-effects. As such, I cannot recommend treatment of sarcoidosis (if that is what you have) with an antibiotic.

Sincerely,

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University