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2613721 
Journal Article 
Abstract 
Characteristics of sarcoidosis in residents and workers exposed to World Trade Center (WTC) dust, gas and fumes presenting for medical care 
Parsia, SS; Yee, H; Young, S; Turetz, ML; Marmor, M; Wilkenfeld, M; Kazeros, A; Caplan-Shaw, CE; Reibman, J 
2010 
Yes 
American Journal of Respiratory and Critical Care Medicine
ISSN: 1073-449X
EISSN: 1535-4970 
181 
A1740 
English 
WOS:000208771000740 
is part of a larger document 3452678 Proceedings of the American Thoracic Society 2010 International Conference, May 14-19, 2010, New Orleans
Rationale: A granulomatous pulmonary disease that resembles sarcoidosis has been described in firefighters exposed to WTC dust/fumes, but less is known about this disease in exposed residents and local workers. We report a case series of clinical and pathologic features of sarcoid in patients attending the WTC Environmental Health Center (WTC EHC) at Bellevue Hospital.

Methods: The WTC EHC is a program for residents, local workers and clean-up workers in the area surrounding Ground Zero. Patients undergo a standardized medical evaluation. Sarcoidosis cases were identified from the database of the WTC EHC, and detailed clinical data were collected via chart review.

Results: We identified 23 patients diagnosed with sarcoidosis with onset after 9/11/01. Of these, 7 (30%) were caught in the initial dust cloud, 14 (61%) were female, 9 (39%) were male with a mean age of 47 years. Race/ethnicity varied: 43% black, 39%white, 17% Hispanic. Onset of illness ranged from 1-7 years after exposure with a median of 4 years. Both dyspnea (91%) and wheeze (52%) were common symptoms upon entry into the WTC EHC. Almost all patients had pulmonary or mediastinal lymph node involvement (22/23) and 1 had disease confined to skin. Many (11/22) with pulmonary sarcoidosis had extrathoracic manifestations of disease including involvement of skin (6), musculoskeletal (3), cardiac (1), Lofgren’s (1) and one patient with disease involving liver and spleen. Pulmonary function results were available for 17 patients and included a mean VC of 78% predicted, TLC 78% predicted and DLCO of 78% predicted. Most patients had normal ACE levels (17/19); two were elevated. Beryllium lymphocyte proliferation tests were negative in 6/6 patients. Pathologic specimens were available for 6 patients and all showed noncaseating granuloma. Birefringent needle-like particles (BRP) were present within histiocytes in specimens from 5/6 patients. Mediastinal lymph nodes were sampled by either mediastinoscopy (4) or transbronchial needle aspiration (TBNA) (1), and parenchymal biopsies were via transbronchial biopsy (2), or video assisted thoracoscopic biopsy (1). BRP were present in 3/3 parenchymal biopsies, and 3/5 mediastinal lymph nodes, including the sample collected via TBNA.

Conclusion: Characteristics of patients with sarcoidosis in the WTC EHC differ from historical cohorts in that they are older and more likely to be white. Most have persistent symptoms and abnormal pulmonary function despite low ACE levels. Pathology was characteristic for sarcoidosis; however the presence of BRP in histiocytes suggests a foreign body response rather than idiopathic granulomatous inflammation. 
American Thoracic Society 2010 International Conference 
New Orleans, LA 
May 14-19, 2010