Misdiagnosis of sarcoidosis in patients with chronic beryllium disease.
OBJECTIVE
Sarcoidosis (SA) is a chronic systemic disorder characterized by infiltration of inflammatory cells in affected organs, resulting in the formation of granulomas. Granulomas are observed in numerous infectious diseases and hypersensitivity reactions (e.g., beryllium). Chronic beryllium disease (CBD) is a multisystem entity caused by dust, fumes or mists of beryllium metal or its salts. Although beryllium has been used for years by several industries in Israel, no case of CBD had ever been reported until recently when we described a 21-year-old female dental technician with CBD who was originally diagnosed as having SA. We launched the current investigation to test the hypothesis that other cases of CBD in Israel were not previously reported because these patients were misdiagnosed as having SA.


METHODS
Forty-seven patients with confirmed-SA from our outpatient clinic were recalled in order to reevaluate their occupational exposure history. We performed the beryllium lymphocyte transformation test (BeLTT) on each patient with a potentially positive environmental exposure anamnesis to beryllium (14/47).


RESULTS
Two of the 14 patients with evidence of granulomas in lung tissue (pulmonary involvement) and 1/14 with extrapulmonary involvement who all had a positive occupational exposure to beryllium and a positive BeLTT test had been erroneously diagnosed as having SA instead of CBD.


CONCLUSIONS
Our findings emphasize the vital importance of taking a comprehensive occupational history in the clinical evaluation of patients suspected of having SA.
Fireman
Elizabeth
E
Institute of Pulmonary and Allergic Diseases-National Laboratory Service for Interstitial Lung Diseases, The Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. fireman@tasmc.health.gov.il
Haimsky
Ela
E
Noiderfer
Meira
M
Priel
Israel
I
Lerman
Yehuda
Y
D000328:Adult; D000368:Aged; D001607:Berylliosis / Q000175:diagnosis* / Q000209:etiology; D001608:Beryllium / Q000009:adverse effects; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D012507:Sarcoidosis / Q000175:diagnosis*
D001608:Beryllium