Significant CD4, CD8, and CD19 lymphopenia in peripheral blood of sarcoidosis patients correlates with severe disease manifestations.
BACKGROUND
Sarcoidosis is a poorly understood chronic inflammatory condition. Infiltration of affected organs by lymphocytes is characteristic of sarcoidosis, however previous reports suggest that circulating lymphocyte counts are low in some patients with the disease. The goal of this study was to evaluate lymphocyte subsets in peripheral blood in a cohort of sarcoidosis patients to determine the prevalence, severity, and clinical features associated with lymphopenia in major lymphocyte subsets.


RESULTS
Lymphocyte subsets in 28 sarcoid patients were analyzed using flow cytometry to determine the percentage of CD4, CD8, and CD19 positive cells. Greater than 50% of patients had abnormally low CD4, CD8, or CD19 counts (p<4x10(-10)). Lymphopenia was profound in some cases, and five of the patients had absolute CD4 counts below 200. CD4, CD8, and CD19 lymphocyte subset counts were significantly correlated (Spearman's rho 0.57, p = 0.0017), and 10 patients had low counts in all three subsets. Patients with severe organ system involvement including neurologic, cardiac, ocular, and advanced pulmonary disease had lower lymphocyte subset counts as a group than those patients with less severe manifestations (CD4 p = 0.0043, CD8 p = 0.026, CD19 p = 0.033). No significant relationships were observed between various medical therapies and lymphocyte counts, and lymphopenia was present in patients who were not receiving any medical therapy.


CONCLUSIONS
Significant lymphopenia involving CD4, CD8, and CD19 positive cells was common in sarcoidosis patients and correlated with disease severity. Our findings suggest that lymphopenia relates more to disease pathology than medical treatment.
Sarcoidosis and Scleroderma Clinic, Section of Rheumatology, University of Chicago, Chicago, Illinois, United States of America. nsweiss@medicine.bsd.uchicago.edu
Nadera J
NJ
Sweiss
Rafah
R
Salloum
Seema
S
Gandhi
Seema
S
Ghandi
Maria-Luisa
ML
Alegre
Ray
R
Sawaqed
Maria
M
Badaracco
Kenneth
K
Pursell
David
D
Pitrak
Robert P
RP
Baughman
David R
DR
Moller
Joe G N
JG
Garcia
Timothy B
TB
Niewold
D018941:Antigens, CD19 / Q000097:blood; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology*; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology*; D005434:Flow Cytometry; D006801:Humans; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets / Q000473:pathology*; D008231:Lymphopenia / Q000097:blood* / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000097:blood* / Q000473:pathology; D012720:Severity of Illness Index
D018941:Antigens, CD19