Sarcoidosis an occupational disease? The need for a mineral dust exposure questionnaire and scanning electron microscopy with EDX analysis

We agreed with the question of Oliver C in a recent article in Chest [1] about “Sarcoidosis: An Occupational Disease ?” and we plead for discontinuing the practice of assigning the idiopathic characterization to all cases of sarcoidosis without in depth questionnaire.

Indeed among the three criteria of American thoracic Society to define the sarcoidosis, the third was the exclusion of alternative causes and particularly foreign body reaction. In our Minasarc study [2], we demonstrated that the search for inorganic exposure was largely insufficient: there was no systematic in depth questionnaire about mineral exposome including occupation but also hobbies, and implanted device for example. There was also insufficient search for foreign bodies in granulomas with no polarized light study mentioned.

In a historical perspective we demonstrated that there were blurred boundaries between pneumoconiosis and sarcoidosis and we proposed to mobilize detection means such as scanning electron microscopy coupled with energy dispersive x-ray spectroscopy (SEM-EDX) analysis [3]. In a recent study about Fallopian tube granulomatosis induced by Essure Implant device used for sterilization we demonstrated the better efficiency of SEM-EDX on simple optical microscopy [4].

We demonstrated the same SEM-EDX interest in a woman having been diagnosed lung sarcoidosis thirty years sooner [5] and after a new sub- diaphragmatic biopsy the transmission electron microscopy coupled with EDX analysis identified many steel particles. After deeper inquiry, the patient admitted using, every week end for more than forty years, sand paper and wire brush to polish wood furnitures as a hobby without no protection.

That is why we suggest that the sarcoidosis diagnosis was only admitted after an in depth questionnaire and at less SEM-EDX analysis of the histologic specimen showing granulomatous and epithelioid cells and multinucleated giant cells.

It would not be possible for talking about idiopathic disease without using a standardized, all along life questionnaire about mineral exposure and modern SEM-EDX allowing chemical analysis of foreign bodies identified associated with granulomas.

We propose a paradigm modification on the manner to question the sarcoidosis diagnosis with use of new tools for identifying a new entity of mineral dust induced granulomatosis.

 

[1] Oliver, LC., Zamke, AM., Sarcoidosis. An occupational study DOI: https://doi;org/10.1016/j.chest.2021.06.003

[2] Catinon, M., Cavalin, C., Chemarin, C., ... & Vincent, M. (2018). Sarcoidosis, inorganic dust exposure and content of bronchoalveolar lavage fluid: the MINASARC pilot study. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases, 35(4), 327.

[3] Vincent, M., Chemarin, C., Cavalin, C., Catinon, M., & Rosental, P. A. (2015). From the definition of silicosis at the 1930 Johannesburg conference to the blurred boundaries between pneumoconioses, sarcoidosis, and pulmonary alveolar proteinosis (PAP). American journal of industrial medicine, 58(S1), 31-38.

[4] Catinon, M., Chemarin, C., Assaad, S.,... & Vincent, M. (2014). Wire brushing wood furniture, granulomatosis and microscopic mineralogical analysis. Sarcoidosis Vasc Diffuse Lung Dis, 31(3), 262-4.

[5] Catinon, M., Roux, E., Auroux, A., ... & Vincent, M. (2020). Identification of inorganic particles resulting from degradation of ESSURE® implants: Study of 10 cases. European Journal of Obstetrics & Gynecology and Reproductive Biology, 250, 162-170.