BAL fluid cells in newly diagnosed pulmonary sarcoidosis with different clinical activity

Abstract

BackgroundSarcoidosis is associated with an increase in the number of alveolar T cells (CD3+ cells) and an increase of the CD3+CD4+ lymphocyte subset. However, the number of lymphocytes and the CD4/CD8 ratio in bronchoalveolar lavage (BAL) fluid are highly variable in sarcoidosis. Comparative studies have demonstrated that geographic and ethnic factors are linked to the specific characteristics of patients with sarcoidosis.Aim of the studyTo investigate peculiarities of BAL fluid (BALF) cell patterns in different clinical activity of pulmonary sarcoidosis at the time of diagnosis.Material and methodsA total of 308 non-treated patients (138 asymptomatic and 170 with sarcoidosis-related symptoms) and 40 previously empirically steroid-treated patients with newly diagnosed sarcoidosis have been prospectively examined.ResultsSignificant BAL fluid lymphocytosis and increased CD4/CD8 ratio were characteristic for all three sarcoidosis patient groups. A total of 12% of asymptomatic patients, 3% of patients with sarcoidosis-related symptoms, and 5% of previously treated symptomatic patients had normal BALF cell counts. Non-treated patients with sarcoidosis-related symptoms had significantly higher lymphocytosis (45±19% versus 39±17%, P<0.01), CD4/CD8 ratio (9.3±5.0 versus 5.7±4.5, P<0.001), and total BALF cell count (411±322 106/mL versus 334±273 106/mL, P<0.05), compared with asymptomatic patients. However, previously treated symptomatic patients had lower lymphocytosis (39±15% versus 45±19%, P=0.058), and total BALF cell count (292±166 106/mL versus 411±322 106/mL, P<0.05) compared with non-treated symptomatic patients. The same trend was noticed for CD4/CD8 ratio (8.3±4.8), although a statistically significant difference was not achieved.ConclusionsIndependently of clinical symptoms at the time of diagnosis sarcoid patients have significantly different BAL fluid cell patterns compared to healthy persons. BAL fluid cell changes are more prominent in corticosteroid non-treated patients with clinically active sarcoidosis. Treatment with systemic corticosteroids may modify typical BALF cellular patterns of sarcoidosis.

Diagnostic role of BAL fluid CD4/CD8 ratio in different radiographic and clinical forms of pulmonary sarcoidosis

“…Sarcoidosis in daily practice is present in various clinical and radiographic forms. We have found previously that BALF cell patterns are related with radiographic stage (26) and clinical symptoms (27) of sarcoidosis. Optimal cutoff point for CD4/CD8 ratio may be different in various manifestations of sarcoidosis.…”

Limited Role of Auxiliary Endobronchial Biopsy in the Diagnosis of Japanese Patients with Sarcoidosis

“…However, these methods have not so far been commonly used or become widespread. On the other hand, lymphocytosis and increased levels of the CD4 + lymphocyte subset in bronchoalveolar lavage (BAL) fluid are well-known findings in patients with sarcoidosis (Costabel et al 1986a;Danila et al 2009). …”

Pulmonary tuberculosis followed by sarcoidosis in an HIV-infected patient: A case report and a simplified diagnostic flowchart for diagnosis and treatment of sarcoidosis

“…In a selected population of sarcoidosis symptomatic patients, Danila et al. [5] found 45 ± 19% lymphocytes in BAL fluid cells, but in patients empirically pretreated with systemic corticosteroids this feature is less pronounced, with 39 ± 15% lymphocytes in the differential count. In severe cases the number of neutrophils may also be augmented [7] .…”