Dines D E, Stubbs S E, McDougall J C
Mayo Clin Proc. 1978 Dec;53(12):788-91.
Stage I sarcoidosis usually presents with roentgenographic evidence of hilar adenopathy and the patients are totally asymptomatic. However, five patients were studied at the Mayo Clinic who had stage I sarcoidosis associated with obstructive disease of the airways. Four of the five presented with dyspnea, wheezing, and cough, and they were found to have expiratory slowing on physical examination. One patient was asymptomatic and her physical examination was normal. On pulmonary function testing, she had a decrease in maximal midexpiratory flow, and at fiberoptic bronchoscopy, mucosal changes consistent with noncaseating granuloma of sarcoidosis were seen. All five patients had the classic roentgenographic appearance of sarcoidosis, with hilar and right paratracheal adenopathy. Endobronchial involvement is well known in sarcoidosis, but its significance in stage I disease has not been emphasized in the literature. An awareness of this possibility is important because it may be an indication for bronchoscopy and mucosal biopsy in the patient with stage I sarcoidosis, particularly when the patient presents with dyspnea, wheezing, and cough. Also, corticosteroid, therapy may be indicated in selected patients with stage I sarcoidosis.
I期结节病通常表现为影像学上肺门淋巴结肿大的证据，且患者完全无症状。然而，梅奥诊所对5例患有与气道阻塞性疾病相关的I期结节病的患者进行了研究。这5例患者中有4例表现为呼吸困难、喘息和咳嗽，体格检查发现呼气减慢。1例患者无症状，体格检查正常。肺功能测试显示，她的最大呼气中期流速降低，在纤维支气管镜检查中，可见与结节病非干酪样肉芽肿一致的黏膜改变。所有5例患者均有结节病典型的影像学表现，伴有肺门和右气管旁淋巴结肿大。结节病中支气管内受累是众所周知的，但在文献中其在I期疾病中的意义尚未得到强调。认识到这种可能性很重要，因为对于I期结节病患者，尤其是出现呼吸困难、喘息和咳嗽的患者，这可能是支气管镜检查和黏膜活检的指征。此外，对于部分I期结节病患者，可能需要使用皮质类固醇进行治疗。
