[Sarcoidosis, chronic obstructive pulmonary disease and viral hepatitis--a challenge for diagnostic and therapy].

HISTORY AND CLINICAL FINDINGS: A 39-year-old smoker noted dyspnoea on exertion and had a dry cough.

INVESTIGATIONS: Pulmonary function test revealed a mainly obstructive ventilatory impairment with only discrete restrictive component. Computed tomography showed bilateral hilar and mediastinal adenopathy with pulmonary parenchymal abnormalities. Transbronchial lung biopsy revealed epitheloid granuloma with giant cells but no central necrosis. Blood tests showed HBs-antigen, anti-HBc-IgG, anti-HBe-IgG/IgM and hepatitis B-DNA.

DIAGNOSIS: These findings indicated pulmonary sarcoidosis, chronic obstructive pulmonary disease and chronic hepatitis-B-infection.

TREATMENT AND COURSE: Considering all revealed pneumological test results and the hepatitis-B-infection, glucocorticosteroids were thought not to be indicated.

CONCLUSION

Even when treatment of sarcoidosis is indicated, all arguments for and against treatment, in particular the presence of co-morbidities and possible negative effects of immunosuppression, should be carefully considered in the individual case before any treatment is initiated.