Tuberculosis in the course of sarcoidosis treatment: is genotyping necessary for personalized therapy?

Pathological similarities between sarcoidosis (SA) and tuberculosis (TB) suggest that mycobacterial antigen(s), in genetically different predisposed hosts, may be a cause of SA. The authors' work and other published comparative analyses of HLA and non-HLA alleles in patients with SA or TB from different ethnic groups in the world revealed that some antigens were connected with high risk of SA or TB development, but others were comparable in both patient populations. The authors also showed a possibility of predominant occurrence of HLA alleles characteristic for TB as a cause of TB in patients with SA on corticosteroid therapy. It is possible that an analysis of SA and TB patient's genetic background may be helpful for protection from TB in SA patients on corticosteroids, especially on anti-TNF-α treatment. The authors suggest that the consideration of an immunosuppressive therapy in SA patients will need more attention and individual therapy based on genotyping study.