[Sarcoidosis, chronic obstructive pulmonary disease and viral hepatitis--a challenge for diagnostic and therapy].
METHODS
A 39-year-old smoker noted dyspnoea on exertion and had a dry cough.


METHODS
Pulmonary function test revealed a mainly obstructive ventilatory impairment with only discrete restrictive component. Computed tomography showed bilateral hilar and mediastinal adenopathy with pulmonary parenchymal abnormalities. Transbronchial lung biopsy revealed epitheloid granuloma with giant cells but no central necrosis. Blood tests showed HBs-antigen, anti-HBc-IgG, anti-HBe-IgG/IgM and hepatitis B-DNA.


METHODS
These findings indicated pulmonary sarcoidosis, chronic obstructive pulmonary disease and chronic hepatitis-B-infection.


METHODS
Considering all revealed pneumological test results and the hepatitis-B-infection, glucocorticosteroids were thought not to be indicated.


CONCLUSIONS
Even when treatment of sarcoidosis is indicated, all arguments for and against treatment, in particular the presence of co-morbidities and possible negative effects of immunosuppression, should be carefully considered in the individual case before any treatment is initiated.
Gompelmann
D R
DR
Pneumologie und Beatmungsmedizin, Thoraxklinik Heidelberg. Daniela.Gompelmann@thoraxklinik-heidelberg.de
Kappes
J
J
Heussel
C-P
CP
Herth
F J F
FJ
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D001706:Biopsy; D001784:Blood Gas Analysis; D001999:Bronchoscopy; D018680:Cholinergic Antagonists / Q000008:administration & dosage; D015897:Comorbidity; D003371:Cough / Q000209:etiology*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000209:etiology*; D005938:Glucocorticoids / Q000008:administration & dosage; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008111:Liver Function Tests; D008168:Lung / Q000473:pathology; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy; D012129:Respiratory Function Tests; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D036542:Tomography, Spiral Computed
D000318:Adrenergic beta-Agonists; D018680:Cholinergic Antagonists; D005938:Glucocorticoids