Sarcoidosis is a multisystem granulomatous disease. Environmental sources of
antigens interact with immune defenses to create the granulomatous response.
Granulomas appear in the lungs and the lymph nodes that receive antigens from
the lungs.Granulomas also appear in the skin and other organs.
Occupational clusters have been reported in health-care workers, US Navy
enlistees, teachers, automobile manufacturers, retail industry workers, and
Granulomatous diseases have been associated with exposures to organic dusts,
metals, chemical dust, silica, wood dust, and smoke. Izbickifollowed 26
fire fighters who developed sarcoidosis after exposure to World Trade Center
dust during the collapse and rescue/recovery efforts. A large number of exposed
citizens developed upper respiratory symptoms, especially a chronic cough and
increase in asthma attacks from inflammation in the upper and lower respiratory
tracts but only a small number developed granulomatous disease.
More than 400 substances were found in samples of WTC dust in four main
categories: (1) particulate matter (calcium carbonate and silica) and fibers (chrysotile
asbestos, fibrous glass, gypsum); (2) organic chemical pollutants, including
polycyclic aromatic hydrocarbons, other hydrocarbons (naphthalene, fluorine,
polychlorinated biphenyl, dibenzo-p-dioxins, and diphenyl ethers), benzene, and
freon; (3) gases, such as carbon monoxide, hydrogen sulfide, combustion
byproducts from WTC fires that burned until mid-December 2001, and diesel
exhaust fumes from the vehicles/machinery employed during the rescue recovery
effort; and (4) heavy metals. Some of these substances had already been
associated with granuloma formation. [i]
[i] Gabriel Izbicki, Robert Chavko, Gisela I. Banauch;
et al World Trade Center "Sarcoid-Like" Granulomatous Pulmonary Disease in New
York City Fire Department Rescue Workers.CHEST.
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