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Thursday, July 31, 2014
Sarcoidosis or lymphoma
MY GRANDSON HAS BEEN EXAMINED RECENTLY FOR SYMPTONS THAT INCLUDE NON PRODUCTIVE COUGHING (FOR SEVERAL YEARS) HE ALSO HAD STOMACH SYMTOMS TO LEAD HIM TO A DIOGNOSIS OF HYATEL (SP.) HERNIA A TWO CENT. TEAR WAS DISCOVERED. NO TREAT MENT NEEDED YET. THIS LED HIM TO A PULMONOLIGIST WHO ORDERED CSCANS LOOKING FOR LYMPHOMA OR SARCOIDOSIS. HE IS 25 YEAR OLD, A STUDENT AND ON THE NATIONAL DEANS LIST. SINCE THE ABOVE POSSIBILITIES ARE SHOCKING TO ME, I AM GOING TO SEEK A SECOND OPINION BEFORE PERMITTING AN INVASION OF HIS LUNGS. QUESTION:THE PULMONOLIGIST WHO EVALUATED THE SCANS AND SUGGESTED THAT HE SE HE HAD PNEUMONIA 12 YEARS AGO. , COULD THE SCAR SEEN ON THE SCAN BE FROM THAT? THERE ARE SEVEARL DOCTORS AT MT. SINAI IN NEW YORK, WHO SPECIALIZE IN SARCOIOSIS. SHOULD I SEEK A SECOND OPINION.OF COURSE I KNOW THE ANSWER BUT HE DOES NOT SEEM ILL AND THESE ARE TERRIBLE ILLNESSES TO DEAL WITH. I UNDERSTAND THERE ARE NON-INVASIVE WAys to determine sarcoidos. true?? and is that a skin test.
thank you for your time.
There is not enough detail in your e-mail to determine if your grandson is at risk for sarcoidosis or lymphoma or even infection, but I assume something was seen on an x-ray or cat scan that was concerning to your doctors. The Kveim skin test for sarcoidosis is not commonly performed anymore because it is not 100% reliable, and there is some risk because it involves injecting treated tissue samples, from a patient with known sarcoidosis, into the patient with suspected sarcoidosis and waiting 6 weeks to see if there is a reaction.
In this context, Dr. Alvin Teirstein (Mt. Sinai Hospital) is one of the leading researchers in the world on the Kveim skin test. No blood test is definitive for sarcoidosis. The most definite test for sarcoidosis (and lymphoma) is a biopsy. In most cases, the procedure is very well tolerated and is not associated with any long-term loss of function.
Getting an opinion from a sarcoidosis expert in your area makes a lot of sense and would reassure your grandson that he is doing the right thing. I hope this information is helpful.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University