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Friday, September 19, 2014
Diagnosis of Sarcoidosis
My foster brother first started having a swollen lymph node in the early part of 2009, in which his doctor provided medication for TB of lymph node. Busy as my brother was, he forgot taking his medication and eventually informed his doctor after a couple of months. Dec 2009, my brother was rushed to the hospital for temporary loss of vision of his left eye and he was unable to move his right hand. We stayed in the hospital for almost two months, the doctors doing a lot of tests but almost concluded he was affected with meningitis in connection to this tuberculosis of lymph node.We were almost hopeless because he became disoriented for days. When we got off the hospital, he began having shortness of breathing, chest pains... and now, he is back in the hospital with his liver affected already and he has fluids in his chest. It took the doctors months to come up with sarcoidosis. When he had the swollen lymph node last year, was that a symptom of Sarcoidosis? My brother is getting weaker, what are the chances of survival from this disease? Is there anything we can do to help him go through this? My brother is only 44 years old and he used to be really active. Please help. We`re from the Philippines
Dear Sir/Madam- Sarcoidosis and tuberculosis can be very difficult to distinguish from one another. Recent studies suggest that some cases of sarcoidosis may be the result of an immune reaction to proteins derived from the organisms that cause tuberculosis. However, the treatments for sarcoidosis and tuberculosis are very different. Thus, it is not surprising that your brother's sarcoidosis progressed despite at least partial treatment for tuberculosis.
As is the case with your brother, some cases of sarcoidosis can involve the eyes and the brain causing severe complications. These cases are particularly difficult because they often require long-term treatment and stronger medications.
The usual approach is to start with a combination of corticosteroids (e.g., prednisone) and a second agent that reduces the reliance on the corticosteroids, such as methotrexate. If this combination fails, we usually add an anti-tumor necrosis factor-alpha drug, such as Remicade or Humira. It is best if a doctor experienced with the treatment of sarcoidosis manages these treatments. Your doctors may be able to identify a person in the Philippines with this type of experience.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University