| Popis: |
Introduction: Recently we published a case report presenting a patient in whom a causal relationship between pulmonary sarcoidosis and infection with Tropheryma whipplei (T. whipplei) could be demonstrated1. To our best knowledge this is the first systematic study investigating the hypothesis, that in a subgroup of patients presumed sarcoidosis is caused by T. whipplei. Patients and Methods: A total of 56 consecutive patients in whom a diagnosis of sarcoidosis was suspected clinically and confirmed histologically were included in this retrospective study (m:f = 21:35, mean age±SD = 53.6±16.2 (range 24–90 years). PCR-examination for T. whipplei was performed in all patients, using formalin-fixed and paraffin-embedded specimens obtained from organs affected by sarcoidosis [lung (n=22), lymph nodes (n=15), skin (n=7), liver (n=6), other organs (n=6)]. All PCR-examinations were done in an international reference laboratory for Whipple9s disease. Results: T. whipplei-RNA was detected in tissues affected by sarcoidosis in 2 of 56 patients (3.6%). Both patients were women (age: 32 and 85 years, respectively) and had enlarged mediastinal and hilar lymph nodes. Histological examination of affected lymph nodes showed granulomatous lymphadenitis of sarcoid type, PAS-staining was negative. Both patients had no gastrointestinal symptoms. Further evaluation for the presence of Whipple9s disease is ongoing. Conclusion: Our findings contribute further evidence to the hypothesis, that in a subgroup of patients presumed sarcoidosis is caused by infection with the bacterium T. whipplei. However, this hypothesis should be further evaluated in prospective studies. 1 Lancet 2007; 369:1832. |
