BRONCHOALVEOLAR LAVAGE IMPACT IN SARCOIDOSIS: Study of 40 cases
Keywords:
Sarcoidosis, Lymphocyte, Bronchoalveolar lavageAbstract
Introduction : Studies on bronchoalveolar lavage (BAL) fluid samples profile characteristics in sarcoidosis patients hitherto reported in literature give rise to conflicting data. The typical finding is lymphocytic alveolitis with a high CD4/CD8 ratio, although a broad range of values has been found.
The aim of the study was to evaluate different parameters of BAL fluid in patients with sarcoidosis before and after corticosteroid treatment and to determine the reliability of BAL in evaluating prognosis of sarcoidosis.
Methods : The study involved 40 patients with clinical and histological evidence of sarcoidosis.
Results : Before treatment, BAL fluid showed an increase in total cell count and a T lymphocytosis with an increase in the CD4/CD8 ratio. After treatment, we have noted a significantly increase in macrophage proportion, a significantly decrease in lymphocyte proportion and in CD4/CD8 ratio. A significant higher CD4/CD8 ratio was noted in patients with multiple extrathoracic lesions compared with patients with only intrathoracic involvement and in patients with unfavourable
evolution compared with patients with improved evolution.
Conclusion : When typical clinical and radiological findings definitely suggest sarcoidosis, BAL results may add a biological support. Our data suggests that a high CD4/CD8 ratio seems to be predictive of poor prognosis with a multiple extrathoracic organ involvement and an unfavourable outcome.
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References
Baughman RP, Drent M. Role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med 2001; 22: 331-41.
Klech H, Hutter C, Costabel U. Clinical guidelines and indications for bronchoalveolar lavage (BAL). Eur Respir Rev 1992; 2: 47-127
Winterbauer R, Lammert J, Selland M, Wu R, Corley D, Springmeyer S. Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest 1993; 104: 352-61.
4 - Shim S. Diagnosis and treatment of sarcoidosis. JAAPA 2006; 19: 30-4.
Capron F. Lavage broncho-alvéolaire. Arch Anat Cytol Path 1997; 45: 255-260.
Kantrow S, Meyer K, Kidd P, Raghu G. The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis. Eur Respir J 1997; 10: 2716-21.
Judson MA. The management of sarcoidosis by the primary care physician. Am J Med 2007; 120: 403-7.
Drent M, Jacobs J, Vries J, Lamers R, Liem I, Wouters E. Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis? Eur Respir J 1999; 13: 1338-44.
Judson MA. Sarcoidosis: Clinical presentation, diagnosis, and approach to treatment. Am J Med Sci 2008; 335: 26-33.
Chorostowska J, Lesniewska D, Krychniak A, Remiszewski P, Sopinski J. Cellular components of the bronchoalveolar lavage correlate with lung function impairment and extrapulmonary involvement markers in active sarcoidosis. Journal of Physiology and pha
Baughman R, Lower E, Roland M. Sarcoidosis. The Lancet 2003; 361:1111-8.
