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Background: Sarcoidosis is an inflammatory granulomatous disease of unknown origin. Lungs and thoracic lymph nodes are most frequently affected. To assess inflammatory process activity, disease activity criteria are to be identified. In clinical practice, bronchoalveolar lavage (BAL) fluid lymphocytes count and blood neopterin levels are commonly used for the monitoring of inflammatory activity in sarcoidosis, though, reliability of the methods may be inadequate. Aim: To assess reliability of BAL fluid lymphocytes count and blood neopterin levels as inflammatory markers in pulmonary sarcoidosis. Materials and methods: BAL fluid lymphocytes counts and blood neopterin levels were measured in 111 patients with pulmonary sarcoidosis. 39 patients had stage I sarcoidosis on chest radiographs, 57 patients had stage II, 15 patients had stage III sarcoidosis. In 28 patients, BAL fluid was sampled from different segments of the lung to compare lymphocytes counts. The results were paralleled with pulmonary function tests, radiographic stage and lung parenchyma changes in computed tomography. Results: Lymphocytes counts in BAL fluid correlated with blood neopterin levels (r=0.26, p=0.027), forced vital capacity value (r=-0.24, p=0.04), and did not correlate with sarcoidosis radiographic stage. In 43% of patients, relative lymphocyte counts in BAL fluid samples from different parts of the lung varied significantly (from 5 to 23%). Normal neopterin levels were detected in 40% of patients with active inflammation. Conclusion: Non-uniform pattern of pulmonary inflammation results in variable lymphocytes counts in BAL fluid samples from different parts of the lung. BAL fluid lymphocytes counts and blood neopterin levels should not be used for reliable monitoring of inflammation in sarcoidosis.

About the authors

S. A. Terpigorev

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul.,
Moscow, 129110, Russian Federation

Author for correspondence.
MD, PhD, Chief of the Department for Occupational Diseases and Medical and Labour Expert Commission Russian Federation

F. N. Paleev

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul.,
Moscow, 129110, Russian Federation

MD, PhD, Professor, Director Russian Federation


  1. Илькович ММ, Новикова ЛН, Лучкевич ВС. Саркоидоз органов дыхания. Руководство для врачей. СПб.; 1996. 66 с. (Il’kovich MM, Novikova LN, Luchkevich VS. Pulmonary sarcoidosis. Guidelines. Saint-Petersburg; 1996. 66 p. Russian).
  2. Визель АА, ред. Саркоидоз: от гипотезы к практике. Казань: ФЭН, Академия наук РТ; 2004. 348 c. (Vizel’ AA, editor. Sarcoidosis: from hypothesis to practice. Kazan’: FEN, Akademiya nauk RT; 2004. 348 p. Russian).
  3. Чучалин АГ, ред. Саркоидоз. Учебно-методическое пособие для слушателей послевузовского и дополнительного профессионального образования. Казань: КГМУ; 2010. 58 с. (Chuchalin AG, editor. Sarcoidosis. Kazan’: KGMU; 2010. 58 p. Russian).
  4. Bargagli E, Mazzi A, Rottoli P. Markers of inflammation in sarcoidosis: blood, urine, BAL, sputum, and exhaled gas. Clin Chest Med. 2008;29(3):445–58, viii.
  5. Gerke AK, Hunninghake G. The immunology of sarcoidosis. Clin Chest Med. 2008;29(3):379– 90, vii.
  6. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999;160(2):736–55.
  7. Wachter H, Fuchs D, Hausen A, Reibnegger G, Werner ER. Neopterin as marker for activation of cellular immunity: immunologic basis and clinical application. Adv Clin Chem. 1989;27:81–141.
  8. Сесь ТП. Особенности воспалительного процесса при саркоидозе легких. Цитокины и воспаление. 2002;(3):3–6. (Ses’ TP. [Specific features of inflammation in pulmonary sarcoidosis]. Tsitokiny i vospalenie. 2002;(3):3–6. Russian).
  9. Semenzato G, Adami F, Maschio N, Agostini C. Immune mechanisms in interstitial lung diseases. Allergy. 2000;55(12):1103–20.
  10. Semenzato G, Bortoli M, Brunetta E, Agostini C. Immunology and pathophysiology. In: Drent M, Costabel U, editors. Sarcoidosis. Eur Respir Mon. 2005;32:49–63.
  11. Danila E, Jurgauskiene L, Norkuniene J, Malickaite R. BAL fluid cells in newly diagnosed pulmonary sarcoidosis with different clinical activity. Ups J Med Sci. 2009;114(1):26–31.
  12. Consensus conference: activity of sarcoidosis. Third WASOG meeting, Los Angeles, USA, September 8-11, 1993. Eur Respir J. 1994;7(3): 624–7.
  13. Heron M, Grutters JC, ten Dam-Molenkamp KM, Hijdra D, van Heugten-Roeling A, Claessen AM, Ruven HJ, van den Bosch JM, van Velzen-Blad H. Bronchoalveolar lavage cell pattern from healthy human lung. Clin Exp Immunol. 2012;167(3):523–31.

Copyright (c) 2016 Terpigorev S.A., Paleev F.N.

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