Sarcoidosis Treatment with Antifungal Medication: A Follow-Up

Introduction. The aim of the study was to compare treatment of sarcoidosis with antifungal or corticosteroid medication. Methods. In patients with sarcoidosis antifungal medication (), corticosteroids () or a combination () was given. Nine patients allotted to antifungal medication were later given corticosteroids because of the lack of regression of the disease. X-ray scores for the severity of granuloma infiltration were determined. Chitotriosidase and angiotensin converting enzyme were determined. The time in months till remission was observed as well as the number of recurrences. 1. Introduction Sarcoidosis is an inflammatory, granulomatous disease present in populations worldwide and with a higher incidence in some ethnic groups [1, 2]. The conventional treatment is with corticosteroids. During recent years there have been an increasing number of studies reporting a connection between sarcoidosis and environmental exposure to fungi [3–5]. Fungal exposure at home was higher among patients with sarcoidosis as compared to controls and highest among those with recurrence of the disease. β-Glucan, a major constituent of the fungal cell wall, has been determined in bronchoalveolar lavage (BAL) fluid in patients with sarcoidosis and controls [6]. The amounts were significantly higher among patients with sarcoidosis and were related to the fungal exposure at home as well as to serum levels of IL-2R and IL-12. These studies showing a relation between exposure to fungi and different experimental and clinical effects have prompted studies where antifungal medication has been given, together with or without simultaneous corticosteroid treatment. In a first study, 18 patients with chronic sarcoidosis were given antifungal medication in addition to the usual corticosteroid treatment. 15 of these patients improved after 6 months [7]. In a subsequent study 39 newly diagnosed patients received corticosteroids for 6 months and 18 received antifungal medication [8]. Pulmonary granuloma infiltration was significantly less severe in the antifungal group as were the values of angiotensin converting enzyme (ACE) and chitotriosidase (CTO). In a case study on osseous sarcoidosis, treatment with antifungal medication improved the condition [9]. These treatment studies covered a relatively short time period and the time till remission or the risk of recurrence was not studied. Before a final conclusion regarding the efficiency of antifungal treatment can be drawn, further studies are required with a larger number of subjects, followed over a longer time period. The present