title: Tunnel excavation triggering pulmonary sarcoidosis.
abstract: BACKGROUND
  A definite cause of sarcoidosis has not been identified, however past research suggests that environmental factors may be triggers of the granulomatous response in genetically susceptible individuals.
  
  
  METHODS
  A 22-year-old male non-smoker, presented with progressive exertional dyspnea and cough of 3 months duration. One year before, when he started working in tunnel excavation, he had a normal chest radiograph. Chest imaging revealed bilateral nodules and masses of peribronchovascular distribution plus mediastinal lymphadenomegaly. Histologic lymph node analysis revealed non-caseating confluent granulomas. Sarcoidosis was diagnosed. The patient was treated with corticosteroids and advised to change jobs. Complete remission of the disease was achieved and persisted for at least one year without steroid treatment.
  
  
  CONCLUSIONS
  Sarcoidosis is believed to have environmental triggers. The timing of the onset of sarcoidosis in this patient following intensive exposure to tunnel dust suggests an environmental contribution. The recognition that sarcoidosis may have occupational triggers have medical, employment, and legal implications.
authors: Pulmonary Division, Heart Institute (InCor), Medical School of the University of São Paulo, São Paulo, Brazil. leticiakawano@hotmail.com
authors: L B
authors: LB
authors: Kawano-Dourado
authors: C R R
authors: CR
authors: Carvalho
authors: U P
authors: UP
authors: Santos
authors: M
authors: M
authors: Canzian
authors: E N A
authors: EN
authors: Coletta
authors: C A C
authors: CA
authors: Pereira
authors: R A
authors: RA
authors: Kairalla
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000473:pathology*; D016273:Occupational Exposure; D011859:Radiography; D017565:Sarcoidosis, Pulmonary / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones