Coexistence of Sarcoidosis and Hypersensitivity Pneumonitis: Diagnostic and Treatment Specificities

The coexistence of sarcoidosis and hypersensitivity pneumonitis (HP) has been described, suggesting a common pathogenic context. <bold>Methods:</bold> Retrospective analysis, through the review of medical records, of patients with sarcoidosis and HP of a tertiary hospital. <bold>Results:</bold> Five Caucasian patients, predominantly male (n=4) and with a recognized antigenic exposure (80%). One patient had an initial diagnosis of HP, two of sarcoidosis, and the other two both conditions simultaneously. The median time difference between the sequential diagnoses was 6 years. Upon diagnosis, patients exhibited respiratory symptoms, restrictive syndrome and reduced carbon monoxide diffusing capacity. Prevalent imaging pattern comprised micronodular (perilymphatic and/or centrilobular) features alongside mediastinal adenopathies (n=3). All patients underwent lung biopsy for diagnostic confirmation. Antigen avoidance was recommended to all patients upon HP diagnosis. Immunosuppressive treatment was managed according to the most active disease with the prescription of various drugs during follow-up. All patients were treated with corticosteroids. The patient diagnosed initially with PH and then sarcoidosis was also treated with methotrexate followed by azathioprine and then rituximab (due to intolerance and disease progression). In the instances of concurrent sarcoidosis and PH it was also necessary to switch the drugs, for instance for cyclophosphamide and then mycophenolate mofetil. Two patients deceased, 11 and 14 years post-second diagnosis. <bold>Conclusions:</bold> The coexistence of sarcoidosis and HP underscores the complexity and necessity of dynamic therapeutic management, tailored to the predominant evolving disease.