OCCURRENCE OF INTRATHORACIC CALCIFICATION IN SARCOIDOSIS

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Abstract
Roentgenographic evidence of thoracic calcifications was found in 10.1% of 256 patients with sarcoidosis observed in Philadelphia. A similar prevalence was found in patients in whom the diagnosis of sarcoidosis was not established. A majority of patients with sarcoidosis with calcification reacted to neither tuberculin nor histoplasmin, and the proportion of calcifications due to healed tuberculosis and histo-plasmosis cannot be determined. Indirect evidence suggests that the calcifications were as often related to histoplasmosis as to tuberculosis. Patients with sarcoidosis reacted less often to tuberculin (30.1%) and histoplasmin (8.5%) than did patients in whom this diagnosis was not established, demonstrating that the disease is responsible for histoplasmin as well as for tuberculin anergy. Reactions to Battery PPD, a tuberculin prepared from unclassified mycobacteria, were obtained in 9 per cent of the patients with sarcoidosis. No relation to the occurrence of calcification was evident. A transient elevation of serum calcium concentrations was noted in 29 per cent of the patients with sarcoidosis, and sustained elevation in less than 3 per cent. No relation to thoracic calcification was apparent. The occurrence of calcification was not related to birthplace or to a history of household contact with tuberculosis. Hilar and mediastinal lymph node calcification developed in only 2 patients with sarcoidosis under observation. One had chromogenic acid-fast bacilli in the sputum, and infection with this organism may have been responsible for the calcification. No evidence of infection with tuberculosis, histoplasmosis, or unclassified acid-fast organisms could be demonstrated in the other patient. The in-frequency with which calcification occurs as a sequel to sarcoidosis in the United States suggests that mycobacteria and fungi are rarely related to sarcoidosis, either as a cause or as a secondary invader.

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