A Case of Sarcoidosis in a Veteran With Military-Related Environmental and Occupational Exposure

Abstract

SESSION TITLE: Occupational and Environmental Lung Diseases SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Sarcoidosis is an idiopathic, noncaseating granulomatous, multi-system disease that most commonly affects the lungs. The etiology of sarcoidosis is unknown, but toxic exposures may trigger the disease. CASE PRESENTATION: A 48-year-old Caucasian male United States Air Force veteran of 7 Iraq and Afghanistan deployments presented with chronic cough and hoarseness and for evaluation of environmental and occupational exposures following diagnosis of sarcoidosis. He joined the military in 1986 and prior to his 1st deployment in 2003, had no health problems. Early in his deployment, he was diagnosed with asthma, well controlled with budesonide and albuterol. The patient never smoked; his mother, a cigarette smoker, died of lung cancer at age 66. During his 5th deployment in 2006, he developed new onset recurrent symptoms of activity intolerance, chest tightness, cough, and green sputum production, but denied fevers or chills. These episodes became more frequent and severe over the next 6 years. He completed military service in 2012. On physical exam in 2014, his lungs were clear to auscultation bilaterally. A CT scan showed mild to moderate mediastinal and hilar lymphadenopathy of uncertain etiology. A mediastinoscopy and lymph node biopsy demonstrated non-necrotizing granulomatous inflammation consistent with sarcoidosis. The patient began hydroxychloroquine. In 2016, he sought evaluation of his occupational and environmental exposures. His military occupation was aircrew life support, which exposed him to petrochemicals, solvents/lubricants, and jet fuel/aircraft engine/diesel exhaust. He also reported environmental exposures to talc, smoke from burn pits, and sand and dust storms. The patient had no significant pre- or post-military exposures. DISCUSSION: There are few studies of the association between toxic exposures and sarcoidosis in military service members. The U.S. Navy examined records since the 1940s suggesting a possible link between sarcoidosis and the removal of non-skid coating from aircraft carriers. Other studies implicate both military and non-military exposures to deck grinding, sandblasting of paint, inorganic dusts, and bioaerosols. While this patient had substantial exposures in temporal association with the onset of sarcoidosis, we cannot say with certainty that these exposures caused his sarcoidosis. CONCLUSIONS: An association between military-related environmental and occupational exposures and the development of sarcoidosis is plausible, but unproven. We recommend that practitioners ask about military service and exposures when evaluating a patient for sarcoidosis to promote further study of the role of military-related exposures and address patients’ search for cause. Reference #1: Under Secretary For Health’s Information Letter: Sarcoidosis. Department of Veteran Affairs Veterans Health Administration. 2007 Jan. IL 10-2007-001. DISCLOSURE: The following authors have nothing to disclose: Daniel Guzman, Bryan Broderick, Anays Sotolongo, Omowunmi Osinubi, Drew Helmer No Product/Research Disclosure Information