Sarcoidosis in Johannesburg, South Africa: A retrospective study

Abstract

Background: Sarcoidosis is a multisystem granulomatous disease of unknown aetiology most commonly affecting the lungs. Because of its similarities clinically and radiologically, and particularly in a high tuberculosis (TB) prevalence region, sarcoidosis is frequently misdiagnosed as TB. The present study was undertaken with the aim of studying the profile of sarcoidosis patients in South Africa. Methods: Retrospective study of patients attending the Charlotte Maxeke Johannesburg Academic Hospital Pulmonology services between 2002 and 2006. Results: Of 102 patients with sarcoidosis, fifty nine were Black, 28 Indian, 8 White and 7 Coloured (mixed race). There were sixty nine females (68%) and 33 (32%) males. The majority (87%) were non-smokers. The median age of the group was 44.6 years. Seventeen percent had been treated for tuberculosis, prior to being diagnosed as having sarcoidosis. Two patients developed active TB whilst being treated for sarcoidosis with corticosteroids. Four patients contracted human immunodeficiency virus infection. Cough was the commonest presenting symptom in 82%, dyspnoea (52%), skin lesions other than erythema nodosum (33%) and crackles (32%) were the other salient clinical manifestations. The majority (48%) had stage II chest x-ray findings. The skin (28%), mediastinal lymph node (26%) and transbronchial lung (26%) biopsies were the most frequent sites confirming granulomatous inflammation. Twenty percent had obstructive airways disease. Systemic corticosteroids were indicated in 84% of patients. Conclusion: Sarcoidosis is often misdiagnosed as TB in South Africa. The most frequent site for histological confirmation was skin, mediastinal lymph node and transbronchial lung biopsy.