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Correspondence |

Increased Number of Pulmonary Embolisms in Sarcoidosis PatientsPulmonary Embolisms in Sarcoidosis Patients FREE TO VIEW

Adriane D. M. Vorselaars, MD; Repke J Snijder, MD; Jan C Grutters, MD, PhD
Author and Funding Information

From the Centre of Interstitial Lung Diseases (Drs Vorselaars and Grutters), Department of Pulmonology (Dr Snijder), St. Antonius Hospital; and the Division of Heart and Lungs (Dr Grutters), University Medical Centre, Utrecht, The Netherlands.

Correspondence to: Adriane D. M. Vorselaars, MD, Department of Pulmonology, Centre of Interstitial Lung Diseases, St. Antonius Hospital, Koekoekslaan 1 3435 CM, Nieuwegein, The Netherlands; e-mail: a.vorselaars@antoniusziekenhuis.nl


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):826-827. doi:10.1378/chest.11-2514
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To the Editor:

We read with great interest the article by Swigris et al1 in a recent issue of CHEST (November 2011), in which the authors found an increased risk of pulmonary embolisms (PEs) among US decedents with sarcoidosis. They found PE in 2.54% of patients’ death certificates, which compares with 1.13% of the background population. A recent observation in our own clinic of two patients with sarcoidosis experiencing extensive PEs triggered our interest in a possible underlying association.

We have conducted a retrospective chart review on treatment outcomes in sarcoidosis. We studied 177 consecutive patients who required immunosuppressive therapy, other than prednisone, between May 2004 and February 2011. Reviewing comorbidities revealed a disproportionally high number of PE (6.2%) in this sarcoidosis cohort (11 of 177 patients).

This PE rate among the patients in our cohort is even higher than the 2.5% mentioned by Swigris et al.1 However, the percentage of PE decendents with sarcoidosis and the percentage of PE in a consecutive cohort of patients with sarcoidosis cannot be compared accurately.

The cohort comprised 107 male patients and 70 female patients (60.5% and 39.5%, respectively). There was no significant difference in the number of PEs between male and female or white and nonwhite patients, as also described by Swigris et al.1 Included patients had various disease presentations, including pulmonary sarcoidosis, uveitis, and neurosarcoidosis.

Besides the study by Swigris et al1 and our cohort, one other study found a twofold-higher rate of PE in sarcoidosis patients in a 35-year record linkage study.2 The cause for the association between sarcoidosis and PE remains speculative. There might be a role for medication (eg, corticosteroid use) or coexistence of an antiphospholipid syndrome.3 Immunosuppressive therapy may have played a role in our cohort, because this was a selected population with severe sarcoidosis and previous or current use of steroids was higher than in the general sarcoidosis population. However, two patients had PE before they started immunosuppressive therapy. We have insufficient information about antiphospholipid syndrome in our cohort. Among the 11 patients who had PE, there was only one current smoker and three former smokers (<10 pack-years). Smoking is not a well-established risk factor for PE and, therefore, not a likely explanation for the high rate of PE in this cohort.

In conclusion, this is another report suggesting a possible association between PE and sarcoidosis. This confirms the need for further prospective studies into the cause and relative risk of this finding.

Swigris JJ, Olson AL, Huie TJ, et al. Increased risk of pulmonary embolism among US decedents with sarcoidosis from 1988-2007. Chest. 2011;1405:1261-1266. [PubMed] [CrossRef]
 
Crawshaw AP, Wotton CJ, Yeates DG, Goldacre MJ, Ho LP. Evidence for association between sarcoidosis and pulmonary embolism from 35-year record linkage study. Thorax. 2011;665:447-448. [PubMed]
 
Takahashi F, Toba M, Takahashi K, et al. Pulmonary sarcoidosis and antiphospholipid syndrome. Respirology. 2006;114:506-508. [PubMed]
 

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References

Swigris JJ, Olson AL, Huie TJ, et al. Increased risk of pulmonary embolism among US decedents with sarcoidosis from 1988-2007. Chest. 2011;1405:1261-1266. [PubMed] [CrossRef]
 
Crawshaw AP, Wotton CJ, Yeates DG, Goldacre MJ, Ho LP. Evidence for association between sarcoidosis and pulmonary embolism from 35-year record linkage study. Thorax. 2011;665:447-448. [PubMed]
 
Takahashi F, Toba M, Takahashi K, et al. Pulmonary sarcoidosis and antiphospholipid syndrome. Respirology. 2006;114:506-508. [PubMed]
 
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